Early versus Delayed Intubation and Technique in COVID-19: A Review Article

Zahid Hussain Khan; Ahmed Maki AL-Dulaimi; Hesam Aldin Varpaei; Parsa Mohammadi; Mostafa Mohammadi

doi:10.18502/aacc.v8i1.8246

Zahid Hussain Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ahmed Maki AL-Dulaimi Department of Anesthesia and Intensive Care Unit, Al-Furat Al-Awsat Hospital, Health and Medical Technical College, Al-Furat Al-Awsat Technical University, Najaf, Iraq.
Hesam Aldin Varpaei Department of Nursing, Faculty of Nursing and Midwifery, Islamic Azad University, Tehran Medical Sciences, Tehran, Iran.
Parsa Mohammadi Tehran University of Medical sciences, Tehran, Iran.
Mostafa Mohammadi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v8i1.8246

Keywords: Coronavirus; Invasive ventilation; Non-invasive ventilation; Tracheal intubation; Intubation; Rapid sequence induction; Critical care

Abstract

Background: The novel coronavirus 2019 is the cause of the 2020 pandemic that was announced by the world health organization in March 2020. The coronavirus attacks the respiratory system and causes mild to severe hypoxemia. Therefore, a fraction of COVID-19 patients may need intubation and mechanical ventilation.

Methods: We conducted a narrative review by searching for articles that mentioned the time of intubation for COVID-19 patients and intubation techniques in PubMed, Google Scholar, Scopus, the Web of scenic, the Cochrane library, and Embase, as well as manual searching. All the selected reviews and studies were limited to humans and the English language.

Results: The first data from China shows that 5% of patients require intubation and mechanical ventilation (MV), and there has been considerable debate about the timing of intubation for patients with acute respiratory failure and the technique of intubation. At first, the specialists recommended early intubation. Although we are more familiar with the pathophysiology of coronavirus, the drawbacks and the benefits of early intubation are still controversial. In addition, the intubation process itself is an aerosol-generating procedure and carries a high risk for patients and health care providers. In this review, we aim to review the previous studies and guidelines recommendations related to the time of intubation and intubation technique for COVID-19 patients.

Conclusion: Previous research has suggested that early tracheal intubation should be prioritized in severe COVID-19 patients, whereas other studies advocate late intubation due to poor intubation outcomes and weaning difficulties. However, intubation timing should be based on personalized medicine and case-by-case decision making to ensure the best care and benefit of patients. And relying only on theoretical justification may not have good consequences.