Anesthesiologists treating patients at the forefront of the coronavirus (COVID-19) outbreak in Wuhan, China, share valuable lessons for other practitioners as the wave of coronavirus infections rolls through other countries. Their first-hand accounts are combined with scholarly review articles in a special article series published today in ANESTHESIOLOGY, the peer-reviewed medical journal of the American Society of Anesthesiologists (ASA).
“Anesthesiologists may encounter and care for patients with COVID-19 through their roles as experts in emergent airway management, acute and intensive care, and perioperative anesthesia,” said Evan D. Kharasch, M.D., Ph.D., editor-in-chief of ANESTHESIOLOGY. “We specifically acknowledge our colleagues who have been and are providing care to patients in China and elsewhere. It is hoped that the experiences and lessons learned and shared by Chinese anesthesiologists can provide worldwide benefit.”
“Coronavirus presents novel and unusual health care challenges, because of the ease of spread, the risk of severe disease, and the substantial threat of infection to the very providers caring for affected patients” explained Dr. Kharasch.
The articles include:
- Perioperative Management of Patients Infected with the Novel Coronavirus
The Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists present recommendations based on their experiences to help anesthesiologists and other health care workers optimize patient care, while protecting patients, providers and the public from being infected. They provide insights into: COVID-19 itself; precautions for infection in general; precautions when caring for patients with suspected or confirmed COVID-19, including anesthesia management; emergency intubation of suspected or confirmed COVID-19 patients; and surveillance of anesthesia providers after caring for infected patients.
Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and Chinese Association of Anesthesiologists
- Intubation and ventilation best practices
Chinese anesthesiologists and intensivists found that timely – but not premature – intubation and ventilation was most effective. It helped open collapsed lungs, improve oxygenation, decrease the strain on lungs and help the lungs heal. The article also underscores the importance of health care workers using strict self-protection precautions while caring for infected patients. Only a small percentage of patients infected with COVID-19 need to be admitted to the intensive care unit for ventilatory support (breathing assistance).
Intubation and Ventilation Amid the COVID-19 Outbreak: Wuhan’s Experience
- Providing resources and support
A variety of efforts to provide support for the approximately 1,000 physician anesthesiologists treating COVID-19 patients in Wuhan and Hubei Province were implemented including free mental health counseling for the providers and an online Q&A forum to answer questions about infection control. The authors report the response to COVID-19 was more efficient than to the 2003 SARS outbreak, but also recommend that providers need to prepare better for future outbreaks by conducting preparedness simulations and drills.
The Response of Chinese Anesthesiologists to the COVID-19 Outbreak
- Setting up a temporary hospital
The number of affected people in China rapidly overwhelmed the capacity of the existing health care system. The Chinese response was to rapidly and emergently establish temporary hospitals to manage patients suspected of infection, similar to mobile medical units used during wartime. The authors relay their experience in setting up the first temporary hospital in Wuhan. The hospitals immediately admit all patients suspected of COVID-19, an approach that helps limit costs, and ease fear and anxiety by containing the source of infection. They detail the importance of following strict infection control standards, smooth coordination and staff management, standardizing procedures and policies, providing education including for implementation of infection control measures, and supply preparation and logistics management.
Establishing and Managing a Temporary Coronavirus Disease 2019 Specialty Hospital in Wuhan, China
- COVID-19 overview
Authors from University of California, San Francisco provide a comprehensive summary of the clinical and research evidence to date about coronavirus and COVID-19. They review disease presentation, management of respiratory failure, therapeutic interventions, and other viral epidemics and guidelines from various organizations. This article provides a comprehensive summary of evidence available to guide management of critically ill patients with COVID-19.
COVID-19 Infection: Implications for Perioperative and Critical Care Physicians
In addition to these five articles, the following letter and editorials provide more insight and context about the pandemic.
Precautions for Intubating Patients with COVID-19 Infections
Novel Coronavirus 2019 and Anesthesiology
Preventing Infection of Patients and Health Care Workers Should be the New Normal in the Era of Novel Coronavirus Epidemics
“We are experiencing unprecedented times and as care providers are asked to respond in new and novel ways,” Dr. Kharasch said. “Our goal is to bring trusted evidence on Coronavirus Disease (COVID-19) to our readers which is why we are sharing these unedited proofs and making them freely available.”
Learn more. https://anesthesiology.pubs.asahq.org/ss/coronavirus.aspx
THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves.
For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/WhenSecondsCount. Like ASA on Facebook, follow ASALifeline on Twitter.
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