Anesth Pain Med.  2017 Apr;12(2):191-194. 10.17085/apm.2017.12.2.191.

The experience of endotracheal intubation in Middle East respiratory syndrome patients: A case report

• Kwon MY
• Kim GH
• Kim B
• Koo MS

• KMID: 2379744
• DOI: http://doi.org/10.17085/apm.2017.12.2.191

Abstract

After Middle East respiratory syndrome (MERS) was first confirmed in Korea on May 20, 2015, a total of 186 confirmed cases and 37 deaths occurred until the announcement of its cessation on December 23, 2015. MERS often causes severe pneumonia; accordingly, many patients require endotracheal intubation for mechanical ventilation. At our hospital, we treated 30 confirmed and 29 suspected cases and performed 9 endotracheal intubations in 8 of these patients, using conventional direct laryngoscopy (DL) and GlideScope video-laryngoscopy (GL). We faced difficulty in conducting endotracheal intubation due to the personal protective equipment and the limited bed height required for managing MERS patients. In such cases, GL improved the ease and direct confirmation of success of endotracheal intubation as compared to DL. In addition, we found that portable end-tidal CO2-monitoring devices may facilitate more precise and reliable confirmation of successful intubation.

Keyword

Airway management; Intubation; Middle East respiratory syndrome coronavirus; Personal protective equipment

MeSH Terms

Airway Management
Coronavirus Infections*
Humans
Intubation
Intubation, Intratracheal*
Korea
Laryngoscopy
Middle East Respiratory Syndrome Coronavirus
Middle East*
Personal Protective Equipment
Pneumonia
Respiration, Artificial

Figure

• 

  Fig. 1 Level C personal protective equipment in frontal view (A) and back view (B).

• 

  Fig. 2 Comparison of conventional direct laryngoscopy (A) and GlideScope video-laryngoscopy (B).

Reference

1. KCDC. Middle East Respiratory Syndrome Coronavirus Outbreak in the Republic of Korea 2015. Osong Public Health Res Perspect. 2015; 6:269–78. DOI: 10.1016/j.phrp.2015.08.006. PMID: 26473095. PMCID: PMC4588443.

2. Zumla A, Hui DS, Perlman S. Middle East respiratory syndrome. Lancet. 2015; 386:995–1007. DOI: 10.1016/S0140-6736(15)60454-8.

3. Arabi YM, Arifi AA, Balkhy HH, Najm H, Aldawood AS, Ghabashi A, et al. Clinical course and outcomes of critically ill patients with Middle East respiratory syndrome coronavirus infection. Ann Intern Med. 2014; 160:389–97. DOI: 10.7326/M13-2486. PMID: 24474051.

4. Baba H, Iinuma Y, Imaizumi K, Hasegawa Y, Hasegawa T, Ohta M, et al. Transmission of bacterial infections to healthcare workers during intubation and respiratory care of patients with severe pneumonia. Infect Control Hosp Epidemiol. 2009; 30:1019–21. DOI: 10.1086/606043. PMID: 19719413.

5. Wilson ME, Spiegelhalter D, Robertson JA, Lesser P. Predicting difficult intubation. Br J Anaesth. 1988; 61:211–6. DOI: 10.1093/bja/61.2.211. PMID: 3415893.

6. Mort TC. Esophageal intubation with indirect clinical tests during emergency tracheal intubation:a report on patient morbidity. J Clin Anesth. 2005; 17:255–62. DOI: 10.1016/j.jclinane.2005.02.004. PMID: 15950848.

7. Ku PK, Tong MC, Ho KM, Kwan A, van Hasselt CA. Traumatic esophageal perforation resulting from endotracheal intubation. Anesth Analg. 1998; 87:730–1. DOI: 10.1213/00000539-199809000-00047.

8. O’Connor RE, Swor RA. Verification of endotracheal tube placement following intubation. National Association of EMS Physicians Standards and Clinical Practice Committee. Prehosp Emerg Care. 1999; 3:248–50. DOI: 10.1080/10903129908958945. PMID: 10424864.

9. Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology. 1995; 82:367–76. DOI: 10.1097/00000542-199502000-00007. PMID: 7856895.

10. Varon AJ, Morrina J, Civetta JM. Clinical utility of a colorimetric end-tidal CO2 detector in cardiopulmonary resuscitation and emergency intubation. J Clin Monit. 1991; 7:289–93. DOI: 10.1007/BF01619347. PMID: 1744672.

11. Aberle SJ, Sandefur BJ, Sunga KL, Campbell RL, Lohse CM, Alecastro Puls H, et al. Intubation Efficiency and Perceived Ease of Use of Video Laryngoscopy vs Direct Laryngoscopy While Wearing HazMat PPE:A Preliminary High-fidelity Mannequin Study. Prehosp Disaster Med. 2015; 30:259–63. DOI: 10.1017/S1049023X15004707. PMID: 25959708.

12. Shin DH, Choi PC, Na JU, Cho JH, Han SK. Utility of the Pentax-AWS in performing tracheal intubation while wearing chemical, biological, radiation and nuclear personal protective equipment:a randomised crossover trial using a manikin. Emerg Med J. 2013; 30:527–31. DOI: 10.1136/emermed-2012-201463. PMID: 23765764.