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 Table of Contents  
Year : 2022  |  Volume : 10  |  Issue : 3  |  Page : 152-153

Airway management practices in COVID ICU during the first and second phases of COVID-19 pandemic: Experience from a tertiary care hospital of Western Uttar Pradesh

Department of Anaesthesiology and Critical Care, Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India

Date of Submission25-Sep-2021
Date of Acceptance11-Oct-2021
Date of Web Publication21-Feb-2023

Correspondence Address:
Nazia Nazir
15/6, Block F, Gautam Buddha University Campus, Greater Noida, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/DYPJ.DYPJ_55_21

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How to cite this article:
Nazir N, Saxena A. Airway management practices in COVID ICU during the first and second phases of COVID-19 pandemic: Experience from a tertiary care hospital of Western Uttar Pradesh. D Y Patil J Health Sci 2022;10:152-3

How to cite this URL:
Nazir N, Saxena A. Airway management practices in COVID ICU during the first and second phases of COVID-19 pandemic: Experience from a tertiary care hospital of Western Uttar Pradesh. D Y Patil J Health Sci [serial online] 2022 [cited 2023 Mar 23];10:152-3. Available from: http://www.dypatiljhs.com/text.asp?2022/10/3/152/370122


Various airway management devices and techniques have been revised and recommended in COVID.[1] In India, during the first wave (April 2020 to November 2020),[2] the strategy included consultant-led intubation teams, the use of video laryngoscopes (VLs), and aerosol box.[3] During the second wave (April 2021 to June 2021),[2] the intubation procedures were modified owing to changes in resources, manpower, and some experience gained from the first wave. This retrospective survey aimed to compare the intubation practice in the ICU of our hospital during the first and second waves of COVID.

All adult patients with respiratory failure secondary to COVID, requiring endotracheal intubation (ETI), in ICU were included. Parameters compared were: seniority of intubator (experience >5 years), first attempt success rate [successful attempt: correct endotracheal tube (ETT) placement confirmed by chest movement, capnography, and expired tidal volume of >8 mL/kg; unsuccessful attempt: failure of insertion of ETT under vision, no chest movement and capnography on ventilation, or time >60 s], desaturation during ETI (pulse oximetry <90%), use of VL (King Vision® with disposable channeled blades), and aerosol box.

Data were retrospectively collected from the medical records for comparison (intubation notes). Eighty intubations were performed in the first wave and 264 in the second wave in our ICU. Using desaturation during ETI as a surrogate marker for the airway event, potential predictors of desaturation were compared. The notable difference between the two cohorts was as follows [Figure 1]:
Figure 1: Comparison of various parameters of the first and second phase COVID-19 pandemic

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  1. Team composition: predominance of senior faculty as primary intubator was higher during the first wave when compared with the second wave (70% vs. 40%). The increased participation of junior doctors as primary intubators was due to the massive surge in the number of COVID patients in the second wave of the pandemic.

  2. The first attempt success rate for ETI was higher in the first wave (85% vs. 70%). The increased number of attempts with higher desaturation episodes observed in the second wave (55% vs. 70%) could be due to the lesser experience of intubator, increased disease severity, and longer duration of NIV support before ETI.

  3. Use of VLs increased in the second phase (50% vs. 90%). Though the use of VL showed promise when used effectively, most of the intubators during the first wave did not utilize this modality. This could be due to a lack of experience and familiarity with VL. Extensive airway education programs were undertaken in our institute between the two waves of the pandemic which increased its use in the second wave.

  4. Use of an aerosol box reduced in the second wave (62% vs. 30%) as its use increased the intubation difficulty and time. A meta-analysis by Lim et al.[4] also concluded that intubation time was significantly longer when an aerosol box was used.

This comparison aims to review and refine our airway management practices. This survey throws light on the importance of ongoing training programs and simulation workshops on airway management, which improve the skills of healthcare professionals. Advancement in skills can improve the outcome trajectory of critically ill patients.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Authors’ contributions

Dr Nazia Nazir contributed to concept, design, the definition of intellectual content, literature search, data acquisition, manuscript preparation, manuscript editing, and manuscript review. Dr Anupriya Saxena contributed to data acquisition, data analysis and statistical analysis, and manuscript editing. All the authors take responsibility for the integrity of the work as a whole from inception to published article and Dr Nazia Nazir is designated as “corresponding author.”

Ethics approval and consent to participate

Not applicable.

Availability of data and material

Not applicable.

  References Top

Orser BA Recommendations for endotracheal intubation of COVID-19 patients. Anesth Analg 2020;130:1109-10.  Back to cited text no. 1
Kar SK, Ransing R, Arafat SMY, Menon V Second wave of COVID-19 pandemic in India: Barriers to effective governmental response. EClinicalMedicine 2021;36:100915.  Back to cited text no. 2
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75:785-99.  Back to cited text no. 3
Lim ZJ, Ponnapa Reddy M, Karalapillai D, Shekar K, Subramaniam A Impact of an aerosol box on time to tracheal intubation: Systematic review and meta-analysis. Br J Anaesth 2021;126:e122-5.  Back to cited text no. 4


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