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

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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.	中华医学会麻醉学分会"围术期肺保护性通气策略临床应用专家共识"工作小组. 围术期肺保护性通气策略临床应用专家共识. 中华麻醉学杂志, 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.	中华医学会麻醉学分会气道管理学组. 新型冠状病毒肺炎危重型患者气管插管术的专家建议 (1.0版). 中华麻醉学杂志, 2020, 40(3): 287-290.
9.	中华医学会麻醉学分会骨科麻醉学组, 中华医学会麻醉学分会青年委员会. 新型冠状病毒肺炎防控疫情后期有序开展择期手术的麻醉预案管理. 麻醉安全与质控, 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.	王天龙, 黄宇光, 陈向东, 等. 新型冠状病毒肺炎老年患者麻醉管理与感染控制建议. 中华麻醉学杂志, 2020, 40(3): 271-274.
19.	中华医学会麻醉学分会老年人麻醉与围术期管理学组, 国家老年疾病临床医学研究中心, 国家老年麻醉联盟. 中国老年患者围手术期麻醉管理指导意见(2020版)(二). 中华医学杂志, 2020, 100(33): 2565-2578.
20.	中国医师协会妇产科医师分会母胎医师专业委员会, 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 等. 妊娠期应用辐射性影像学检查的专家建议. 中华围产医学杂志, 2020, 23(3): 145-149.
21.	周志强, 孙星星, 李世勇, 等. 新型冠状病毒肺炎流行期间剖宫产术的麻醉管理. 中华麻醉学杂志, 2020, 40(3): 291-295.
22.	胡瑶琴, 黄瑾瑾, 王金湖, 等. 小儿外科疑似或确诊新型冠状病毒感染患者的麻醉管理建议. 临床小儿外科杂志, 2020, 19(2): 111-114.
23.	谢冬, 王思桦, 姜格宁, 等. 新型冠状病毒肺炎疫情下胸外科面临的挑战与对策. 中国胸心血管外科临床杂志, 2020, 27(4): 359-363.
24.	李辉, 游宾, 区颂雷, 等. 新冠疫情期间胸外科手术风险管控的几点建议. 中国胸心血管外科临床杂志, 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.	马武华, 仓静, 邓小明, 等. 气管导管拔除的专家共识(2020版). (2023-1-17)[2023-1-28]. https://www.cn-healthcare.com/articlewm/20210801/content-1248272.html.
27.	北京市临床麻醉质量控制和改进中心专家组. 麻醉科防控新型冠状病毒肺炎工作建议(第1版). 麻醉安全与质控, 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. 中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局综合司. 新型冠状病毒感染诊疗方案(试行第十版). 中国医药, 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. 中华医学会麻醉学分会"围术期肺保护性通气策略临床应用专家共识"工作小组. 围术期肺保护性通气策略临床应用专家共识. 中华麻醉学杂志, 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. 中华医学会麻醉学分会气道管理学组. 新型冠状病毒肺炎危重型患者气管插管术的专家建议 (1.0版). 中华麻醉学杂志, 2020, 40(3): 287-290.
9. 中华医学会麻醉学分会骨科麻醉学组, 中华医学会麻醉学分会青年委员会. 新型冠状病毒肺炎防控疫情后期有序开展择期手术的麻醉预案管理. 麻醉安全与质控, 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. 王天龙, 黄宇光, 陈向东, 等. 新型冠状病毒肺炎老年患者麻醉管理与感染控制建议. 中华麻醉学杂志, 2020, 40(3): 271-274.
19. 中华医学会麻醉学分会老年人麻醉与围术期管理学组, 国家老年疾病临床医学研究中心, 国家老年麻醉联盟. 中国老年患者围手术期麻醉管理指导意见(2020版)(二). 中华医学杂志, 2020, 100(33): 2565-2578.
20. 中国医师协会妇产科医师分会母胎医师专业委员会, 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 等. 妊娠期应用辐射性影像学检查的专家建议. 中华围产医学杂志, 2020, 23(3): 145-149.
21. 周志强, 孙星星, 李世勇, 等. 新型冠状病毒肺炎流行期间剖宫产术的麻醉管理. 中华麻醉学杂志, 2020, 40(3): 291-295.
22. 胡瑶琴, 黄瑾瑾, 王金湖, 等. 小儿外科疑似或确诊新型冠状病毒感染患者的麻醉管理建议. 临床小儿外科杂志, 2020, 19(2): 111-114.
23. 谢冬, 王思桦, 姜格宁, 等. 新型冠状病毒肺炎疫情下胸外科面临的挑战与对策. 中国胸心血管外科临床杂志, 2020, 27(4): 359-363.
24. 李辉, 游宾, 区颂雷, 等. 新冠疫情期间胸外科手术风险管控的几点建议. 中国胸心血管外科临床杂志, 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. 马武华, 仓静, 邓小明, 等. 气管导管拔除的专家共识(2020版). (2023-1-17)[2023-1-28]. https://www.cn-healthcare.com/articlewm/20210801/content-1248272.html.
27. 北京市临床麻醉质量控制和改进中心专家组. 麻醉科防控新型冠状病毒肺炎工作建议(第1版). 麻醉安全与质控, 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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