Endotracheal Intubation in Patients with COVID-19 in Priest Hospital during COVID-19 Pandemic: A Retrospective Study

Background: Coronavirus disease 2019 (COVID-19) is a new respiratory tract infection. In Thailand, it was first recognized on 12 Jan 2021. At Priest hospital the first patient was identified on 17 March 2021. While most patients with COVID-19 have no or mild symptoms, severe cases develop acute respiratory failure and need endotracheal tube intubation, including patients who need general anesthesia for surgery. We aimed to collect information of COVID-19 patients with endotracheal tube intubation included demographic patient data, techniques of intubation, complications after intubation and prevalence of COVID-19 associated infection to health care personnel performing intubation. Method: A retrospective study of all COVID-19 patients admitted and underwent endotracheal tube intubation in Priest Hospital between 1 January 2021 and 31 December 2021 were performed. Doctors and nurse anesthetists were intubation teams. They observed for symptoms of COVID-19 infection and they tested COVID-19 antigen test kit every week. Results: There was a total of 752 COVID-19 patients with confirmed Severe Acute Respiratory Syndrome-Cononavirus-2 (SARS-CoV-2) infection by real time polymerase chain reaction (RT-PCR) admitted from January 1 to December 31, 2021. Of these, a total of 14 COVID-19 patients needed intubation. 13 patients were intubated due to acute respiratory failure and 1 patient was intubated for general anesthesia. All of the patients were male because they were monks. Endotracheal intubations were performed in a negative pressure isolation room or isolation room. The help care personnel used full personal protective equipment (PPE) in all cases. At minimum, the full PPE included a respirator with a rating of N95 or higher, gowns, gloves and eye protection. We performed endotracheal tube intubation with the use of video laryngoscope and endotracheal tube stylet in all cases. There was one cause of failed intubation under video laryngoscope, but the performer accomplished successful intubation using Macintosh laryngoscope. Six patients received hypnotic drugs and neuromuscular blocking agents for rapid sequence induction. Two patients received only sedative drugs for intubation and 6 patients did not receive any drug for intubation. After intubation, only one patient significantly showed desaturation In total, 9 help care personnel were intubation teams (4 doctors and 5 nurse anesthetists). None of them was infected with COVID-19 within 2 weeks after performing this procedure. Conclusion: In severe cases, patients with COVID-19 infection may develop acute respiratory failure which need endotracheal tube intubation. Endotracheal tube intubation in patients with COVID-19 poses a risk of infection for the health care personnel involved in the procedure. In this study none among the personnel performing intubation was infected with COVID-19. The results suggest that, full personal protective equipment, video laryngoscopy, skills with multiple intubation techniques and proper medications were important components for patients and health care personnel's safety.