Author: Dr Matthew Durie
Peer reviewer: Dr Vinodh Nanjayya
Australian and New Zealand Intensive Care Society (2020). ANZICS COVID-19 Guidelines Version 1. Melbourne: ANZICS. [accessed Mar 16 2020] Available at URL: https://www.anzics.com.au/wp-content/uploads/2020/03/ANZICS-COVID-19-Guidelines-Version-1.pdf
Brewster D, Chrimes N, Do T et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. 2020 Mar 16. [accessed Mar 19 2020] Available at URL: https://www.mja.com.au/journal/2020/212/10/consensus-statement-safe-airway-society-principles-airway-management-and
March 16 saw two notable COVID-19 guidelines published, which will aid clinicians in Australian and New Zealand ICUs preparing for managing patients with the disease.
The first is the Australian and New Zealand Intensive Care Society (ANZICS) COVID-19 Guidelines.
In three sections, this paper describes strategies for operational planning for a pandemic, establishing a safe and sustainable working environment and the identification and treatment of patients with COVID-19.
It advocates a tiered, whole-system approach to planning and responding to an event that will likely exceed available ICU resources and provides clear recommendations for health services and clinicians. The paper also discusses issues around safe airway management, intra-hospital transport of patients and resuscitation of suspected affected patients. In the patient management section, it provides clear recommendations for the management of respiratory failure and ARDS due to COVID-19, as well as advice regarding potential experimental therapies for COVID-19.
The second publication is the Safe Airway Society (Australia and New Zealand) Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group.
This paper reviews the risks associated with respiratory and airway management in the SARS-CoV-2 infected patient, including high-flow oxygen, non-invasive ventilation, tracheal intubation and other airway procedures including front of neck access. It alsopresents a set of guidelines to mitigate the risk of viral transmission.
While it is not possible to fully replicate these guidelines here, the key considerations include:
- Ensuring airway management is performed in an appropriate environment (ideally negative pressure room),
- Preparation of equipment and monitoring and measures to reduce transmission (including viral filters and disposable equipment),
- Avoidance of aerosol-generating procedures, including non-invasive ventilation (also mirrored in the ANZICS guidelines above)
- Team selection, including the most experienced clinician to perform the airway intervention,
- Rapid sequence intubation with videolaryngoscopy as the default technique, to reduce the risk of aerosolization.
The CICM, ANZICS, the ASA and others have endorsed these guidelines, and are well worth detailed review.
Disclaimer: while correct at the time of writing, the reader should ensure they are reviewing the latest available version of the above guideline(s).