Perioperative mechanical ventilation strategy for COVID-19 patients: Recommendation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 YU Hai ,  ZHENG Hong , ZHUANG Huijia , HAN Yang , HUANG Zhiyu , The Society of Anesthesiology, Chengdu Medical Association

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

YU Hai, Email: yuhai@scu.edu.cn; ZHENG Hong, Email: Xjzhenghong@aliyun.com

Keywords：

Coronavirus disease 2019 (COVID-19); mechanical ventilation; perioperative care

DOI：

10.7507/1007-4848.202302022

Video：

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Since December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has gradually spread all over the world. With the implementation of class B infectious disease management policy for coronavirus disease 2019 (COVID-19), China has experienced a pandemic. For patients receiving a time-sensitive or emergency surgery, SARS-CoV-2 infection may increase the risk of postoperative pulmonary complications. An appropriate perioperative mechanical ventilation strategy, such as lung protective ventilation strategy, is particularly important for preventing postoperative pulmonary complications in patients undergoing general anesthesia. In addition, how to protect medical personnel from being infected is also the focus we need to pay attention to. This article will discuss the perioperative mechanical ventilation strategy for COVID-19 patients and the protection of medical personnel, in order to provide reference for the development of guidelines.

Citation： YU Hai, ZHENG Hong, ZHUANG Huijia, HAN Yang, HUANG Zhiyu, The Society of Anesthesiology, Chengdu Medical Association. Perioperative mechanical ventilation strategy for COVID-19 patients: Recommendation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 501-505. doi: 10.7507/1007-4848.202302022 Copy

1.	中華人民共和國國家衛生健康委員會辦公廳, 中華人民共和國國家中醫藥管理局綜合司. 新型冠狀病毒感染診療方案(試行第十版). 中國醫藥, 2023, 18(2): 161-166.
2.	Marquez C, Kerkhoff AD, Schrom J, et al. COVID-19 symptoms and duration of rapid antigen test positivity at a community testing and surveillance site during pre-delta, delta, and Omicron BA. 1 periods. JAMA Netw Open, 2022, 5(10): e2235844.
3.	Wang M, Liu Z, Wang Z, et al. Clinical characteristics of 1139 mild cases of the SARS-CoV-2 Omicron variant infected patients in Shanghai. J Med Virol, 2023, 95(1): e28224.
4.	El-Boghdadly K, Cook TM, Goodacre T, et al. SARS-CoV-2 infection, COVID-19 and timing of elective surgery: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Peri-operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England. Anaesthesia, 2021, 76(7): 940-946.
5.	COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
6.	中華醫學會麻醉學分會"圍術期肺保護性通氣策略臨床應用專家共識"工作小組. 圍術期肺保護性通氣策略臨床應用專家共識. 中華麻醉學雜志, 2020, 40(5): 513-519.
7.	Tunescu M, Christodorescu R, Sharma A, et al. The preoperative evaluation of post-COVID-19 patients scheduled for elective surgery—What is important not to miss! Eur Rev Med Pharmacol Sci, 2021, 25(23): 7607-7615.
8.	中華醫學會麻醉學分會氣道管理學組. 新型冠狀病毒肺炎危重型患者氣管插管術的專家建議 (1.0版). 中華麻醉學雜志, 2020, 40(3): 287-290.
9.	中華醫學會麻醉學分會骨科麻醉學組, 中華醫學會麻醉學分會青年委員會. 新型冠狀病毒肺炎防控疫情后期有序開展擇期手術的麻醉預案管理. 麻醉安全與質控, 2020, 4(3): 125-130.
10.	Shrimpton AJ, Gregson FKA, Brown JM, et al. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia, 2021, 76(12): 1577-1584.
11.	Guarracino F, Shernan SK, Tahan ME, et al. EACTA/SCA recommendations for the cardiac anesthesia management of patients with suspected or confirmed COVID-19 infection: An expert consensus from the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists with endorsement from the Chinese Society of Cardiothoracic and Vascular Anesthesiology. J Cardiothorac Vasc Anesth, 2021, 35(7): 1953-1963.
12.	Gong Y, Cao X, Mei W, et al. Anesthesia considerations and infection precautions for trauma and acute care cases during the COVID-19 pandemic: Recommendations from a Task Force of the Chinese Society of Anesthesiology. Anesth Analg, 2020, 131(2): 326-334.
13.	Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: Different respiratory treatments for different phenotypes? Intensive Care Med, 2020, 46(6): 1099-1102.
14.	Jackson K, Wands B. Review of anesthesia versus intensive care unit ventilators and ventilatory strategies: COVID-19 patient management implications. AANA J, 2021, 89(1): 62-69.
15.	Gertler R. Mechanical ventilation during anesthesia in adults. (2023-1-4)[2023-1-28]. https://www.uptodate.com/contents/mechanical-ventilation-during-anesthesia-in-adults!.
16.	Boscolo A, Sella N, Lorenzoni G, et al. Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS. Crit Care, 2021, 25(1): 263.
17.	Zanella A, Florio G, Antonelli M, et al. Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units. Intensive Care Med, 2021, 47(9): 995-1008.
18.	王天龍, 黃宇光, 陳向東, 等. 新型冠狀病毒肺炎老年患者麻醉管理與感染控制建議. 中華麻醉學雜志, 2020, 40(3): 271-274.
19.	中華醫學會麻醉學分會老年人麻醉與圍術期管理學組, 國家老年疾病臨床醫學研究中心, 國家老年麻醉聯盟. 中國老年患者圍手術期麻醉管理指導意見(2020版)(二). 中華醫學雜志, 2020, 100(33): 2565-2578.
20.	中國醫師協會婦產科醫師分會母胎醫師專業委員會, 中華醫學會婦產科學分會產科學組, 中華醫學會圍產醫學分會, 等. 妊娠期應用輻射性影像學檢查的專家建議. 中華圍產醫學雜志, 2020, 23(3): 145-149.
21.	周志強, 孫星星, 李世勇, 等. 新型冠狀病毒肺炎流行期間剖宮產術的麻醉管理. 中華麻醉學雜志, 2020, 40(3): 291-295.
22.	胡瑤琴, 黃瑾瑾, 王金湖, 等. 小兒外科疑似或確診新型冠狀病毒感染患者的麻醉管理建議. 臨床小兒外科雜志, 2020, 19(2): 111-114.
23.	謝冬, 王思樺, 姜格寧, 等. 新型冠狀病毒肺炎疫情下胸外科面臨的挑戰與對策. 中國胸心血管外科臨床雜志, 2020, 27(4): 359-363.
24.	李輝, 游賓, 區頌雷, 等. 新冠疫情期間胸外科手術風險管控的幾點建議. 中國胸心血管外科臨床雜志, 2023, 30(2): 159-161.
25.	Thornton M, Reid D, Shelley B, et al. Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and Ireland. Anaesthesia, 2020, 75(11): 1509-1516.
26.	馬武華, 倉靜, 鄧小明, 等. 氣管導管拔除的專家共識(2020版). (2023-1-17)[2023-1-28]. https://www.cn-healthcare.com/articlewm/20210801/content-1248272.html.
27.	北京市臨床麻醉質量控制和改進中心專家組. 麻醉科防控新型冠狀病毒肺炎工作建議(第1版). 麻醉安全與質控, 2020, 4(1): 1-4.
28.	Saracoglu KT, Dalkilinc Hokenek U, Saracoglu A, et al. COVID-19 patients in the operating room: A concise review of existing literature. Minerva Anestesiol, 2021, 87(5): 604-612.

1. 中華人民共和國國家衛生健康委員會辦公廳, 中華人民共和國國家中醫藥管理局綜合司. 新型冠狀病毒感染診療方案(試行第十版). 中國醫藥, 2023, 18(2): 161-166.
2. Marquez C, Kerkhoff AD, Schrom J, et al. COVID-19 symptoms and duration of rapid antigen test positivity at a community testing and surveillance site during pre-delta, delta, and Omicron BA. 1 periods. JAMA Netw Open, 2022, 5(10): e2235844.
3. Wang M, Liu Z, Wang Z, et al. Clinical characteristics of 1139 mild cases of the SARS-CoV-2 Omicron variant infected patients in Shanghai. J Med Virol, 2023, 95(1): e28224.
4. El-Boghdadly K, Cook TM, Goodacre T, et al. SARS-CoV-2 infection, COVID-19 and timing of elective surgery: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Peri-operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England. Anaesthesia, 2021, 76(7): 940-946.
5. COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: An international cohort study. Lancet, 2020, 396(10243): 27-38.
6. 中華醫學會麻醉學分會"圍術期肺保護性通氣策略臨床應用專家共識"工作小組. 圍術期肺保護性通氣策略臨床應用專家共識. 中華麻醉學雜志, 2020, 40(5): 513-519.
7. Tunescu M, Christodorescu R, Sharma A, et al. The preoperative evaluation of post-COVID-19 patients scheduled for elective surgery—What is important not to miss! Eur Rev Med Pharmacol Sci, 2021, 25(23): 7607-7615.
8. 中華醫學會麻醉學分會氣道管理學組. 新型冠狀病毒肺炎危重型患者氣管插管術的專家建議 (1.0版). 中華麻醉學雜志, 2020, 40(3): 287-290.
9. 中華醫學會麻醉學分會骨科麻醉學組, 中華醫學會麻醉學分會青年委員會. 新型冠狀病毒肺炎防控疫情后期有序開展擇期手術的麻醉預案管理. 麻醉安全與質控, 2020, 4(3): 125-130.
10. Shrimpton AJ, Gregson FKA, Brown JM, et al. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia, 2021, 76(12): 1577-1584.
11. Guarracino F, Shernan SK, Tahan ME, et al. EACTA/SCA recommendations for the cardiac anesthesia management of patients with suspected or confirmed COVID-19 infection: An expert consensus from the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists with endorsement from the Chinese Society of Cardiothoracic and Vascular Anesthesiology. J Cardiothorac Vasc Anesth, 2021, 35(7): 1953-1963.
12. Gong Y, Cao X, Mei W, et al. Anesthesia considerations and infection precautions for trauma and acute care cases during the COVID-19 pandemic: Recommendations from a Task Force of the Chinese Society of Anesthesiology. Anesth Analg, 2020, 131(2): 326-334.
13. Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: Different respiratory treatments for different phenotypes? Intensive Care Med, 2020, 46(6): 1099-1102.
14. Jackson K, Wands B. Review of anesthesia versus intensive care unit ventilators and ventilatory strategies: COVID-19 patient management implications. AANA J, 2021, 89(1): 62-69.
15. Gertler R. Mechanical ventilation during anesthesia in adults. (2023-1-4)[2023-1-28]. https://www.uptodate.com/contents/mechanical-ventilation-during-anesthesia-in-adults!.
16. Boscolo A, Sella N, Lorenzoni G, et al. Static compliance and driving pressure are associated with ICU mortality in intubated COVID-19 ARDS. Crit Care, 2021, 25(1): 263.
17. Zanella A, Florio G, Antonelli M, et al. Time course of risk factors associated with mortality of 1260 critically ill patients with COVID-19 admitted to 24 Italian intensive care units. Intensive Care Med, 2021, 47(9): 995-1008.
18. 王天龍, 黃宇光, 陳向東, 等. 新型冠狀病毒肺炎老年患者麻醉管理與感染控制建議. 中華麻醉學雜志, 2020, 40(3): 271-274.
19. 中華醫學會麻醉學分會老年人麻醉與圍術期管理學組, 國家老年疾病臨床醫學研究中心, 國家老年麻醉聯盟. 中國老年患者圍手術期麻醉管理指導意見(2020版)(二). 中華醫學雜志, 2020, 100(33): 2565-2578.
20. 中國醫師協會婦產科醫師分會母胎醫師專業委員會, 中華醫學會婦產科學分會產科學組, 中華醫學會圍產醫學分會, 等. 妊娠期應用輻射性影像學檢查的專家建議. 中華圍產醫學雜志, 2020, 23(3): 145-149.
21. 周志強, 孫星星, 李世勇, 等. 新型冠狀病毒肺炎流行期間剖宮產術的麻醉管理. 中華麻醉學雜志, 2020, 40(3): 291-295.
22. 胡瑤琴, 黃瑾瑾, 王金湖, 等. 小兒外科疑似或確診新型冠狀病毒感染患者的麻醉管理建議. 臨床小兒外科雜志, 2020, 19(2): 111-114.
23. 謝冬, 王思樺, 姜格寧, 等. 新型冠狀病毒肺炎疫情下胸外科面臨的挑戰與對策. 中國胸心血管外科臨床雜志, 2020, 27(4): 359-363.
24. 李輝, 游賓, 區頌雷, 等. 新冠疫情期間胸外科手術風險管控的幾點建議. 中國胸心血管外科臨床雜志, 2023, 30(2): 159-161.
25. Thornton M, Reid D, Shelley B, et al. Management of the airway and lung isolation for thoracic surgery during the COVID-19 pandemic: Recommendations for clinical practice endorsed by the Association for Cardiothoracic Anaesthesia and Critical Care and the Society for Cardiothoracic Surgery in Great Britain and Ireland. Anaesthesia, 2020, 75(11): 1509-1516.
26. 馬武華, 倉靜, 鄧小明, 等. 氣管導管拔除的專家共識(2020版). (2023-1-17)[2023-1-28]. https://www.cn-healthcare.com/articlewm/20210801/content-1248272.html.
27. 北京市臨床麻醉質量控制和改進中心專家組. 麻醉科防控新型冠狀病毒肺炎工作建議(第1版). 麻醉安全與質控, 2020, 4(1): 1-4.
28. Saracoglu KT, Dalkilinc Hokenek U, Saracoglu A, et al. COVID-19 patients in the operating room: A concise review of existing literature. Minerva Anestesiol, 2021, 87(5): 604-612.

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