![]() ![]() After the tracheal tube is clamped and seen to pass the vocal cords on the video laryngoscope, a heat and moisture exchanger (HME) filter, a mainstream capnography and a mechanical ventilator are connected. No manual ventilation is performed to avoid aerosol transmission. Accordingly, pre oxygenation is performed using nasal oxygen for 3–5 min, after which, induction is achieved using the midazolam, ketamine or propofol available in the area in a full dose appropriate for the vital signs and patient weight, and a full dose of vecuronium citrate, a neuromuscular blocker, is administered, again in accordance with the protocol. The intubation of patients is performed in accordance with the infection prevention protocol ( 7, 8, 15, 11). The results of arterial blood gas analyses obtained at admission and 15 min after intubation (pH, lactate, bicarbonate (HCO3), partial pressure of arterial blood oxygen and carbon dioxide) are recorded. The thoracic tomography scans of the patients are classified as Type 1: typical appearance of COVID-19 pneumonia, Type 2: indeterminate features of COVID-19 pneumonia, Type 3: presence of pneumonia, but absence of COVID-19 features, and Type 4: absence of pneumonia in accordance with the system proposed by the Radiology Society of North America (RSNA) ( 14). Fever, heart rate, respiration rate, arterial blood pressure, thoracic tomography findings and laboratory findings are recorded. The demographic characteristics of the patients, such as age and gender, as well as any comorbidities, are recorded. ![]() A video laryngoscope (Medan®) and intubation cabinet are used, and three sizes of endotracheal tube, as well as the stylets and medications required for anesthesia induction and resuscitation are kept available. ![]() All personnel use Level 3 personnel protective equipment (PPE). The objective of the present study is to establish the value of P ETCO2 measured by capnography in confirmed COVID-19 patients intubated in emergency department, and to determine its effects on mortality.ĬOVID-19 patients with the need for intubation as determined by examinations and tests are transferred to a separate area in which a physician, a senior resident, a nurse and a member of hospital staff are in attendance. In this period, all hospitals were designated as COVID-19 referral hospitals, and our hospital also provided intensive care services to COVID-19 patients in most of the emergency department. Turkey experienced the second peak of the outbreak in November 2020 ( 13). COVID-19, which has been declared a pandemic by the World Health Organization (WHO), had been reported to have affected more than 175,000,000 confirmed cases including 3.792.777 deaths ( 12). Mortality among critical patients is in the 16.7–61.5% range ( 6). Furthermore, 5% of patients experience septic shock and multiple organ dysfunction syndrome (MODS), and 2–3% require tracheal intubation ( 10, 11). According to case reports, more than 80% of patients with the disease present with mild fever, while 14–17% develop acute respiratory distress syndrome (ARDS), leading to severe respiratory distress ( 9, 10). As such, the P ETCO2 measured immediately after the intubation of the patient allows the ventilation status of the patient to be ascertained.ĬOVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is an encapsulated virus containing ribonucleic acid ( 6- 8). P ETCO2 represents the partial pressure or maximal concentration of carbon dioxide at the end of exhalation ( 4, 5). Capnography refers to the measurement of the partial CO 2 pressure (P ETCO2) in the respiratory gases of mechanically ventilated patients and is used routinely for the monitoring of endotracheal tube position, for the assessment of the effectiveness of cardiopulmonary resuscitation (CPR), for the monitoring of ventilation during interventional sedation and analgesia, for the ventilation monitoring of unconscious patients and for the assessment of respiratory diseases ( 1- 3). ![]()
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