CHEST Guidelines-Evolving-Tracheal-Intubation-Practice-Patterns-in-

Evolving-Tracheal-Intubation-Practice-Patterns-in-

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The COVID-19 pandemic demanded global adjustments in tracheal intubation practices due to the high severity of illness and increased risk to airway operators. The pandemic era saw the adoption of new intubation techniques aimed at minimizing aerosol generation, reducing operator exposure, and improving procedural efficiency. A study by Nauka et al. analyzed the real-world effects of pandemic-introduced guidelines at a large academic medical center, comparing intubation techniques, outcomes, and complications before and during the pandemic.<br /><br />The retrospective study involved two cohorts: a prepandemic group (782 patients from July 2019 to March 2020) and a pandemic group (478 patients from March 2020 to May 2020). Findings revealed a significant shift towards using video laryngoscopy and neuromuscular blockade during intubations in the pandemic period, with decreased usage of bag mask preoxygenation. These changes led to an improved rate of first-pass success (94.6% vs 82.9%) but also resulted in higher complication rates, notably due to hypoxemia (25.7% vs 8.2%).<br /><br />While increased first-pass success was noted, the retrospective nature of the study makes it hard to pinpoint exact factors responsible for this improvement. Increased use of video laryngoscopy might contribute to success rates; however, no consistent evidence supports this from prospective trials. Despite improved technique, first-pass success alone is insufficient to prevent complications, which are also influenced by procedural and patient factors.<br /><br />The study highlights pandemic-driven changes like reduced bag mask usage and discouraged postinduction bag mask ventilation, potentially affecting hypoxemia rates. Findings suggest a need for careful reevaluation of intubation practices post-pandemic, with an emphasis on evidence-based strategies balancing patient safety and procedural success. The editorial underscores the complexity of intubation practices and the need for nuanced outcome measures beyond first-pass success.

Keywords

COVID-19 pandemic

tracheal intubation

aerosol generation

video laryngoscopy

neuromuscular blockade

first-pass success

hypoxemia

bag mask preoxygenation

intubation complications

evidence-based strategies