Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study
Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study
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DOI：
10.1111/anae.15170
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发表时间：
2020-11-01
期刊：
影响因子：
10.7
通讯作者：
Ahmad, I.
中科院分区：
文献类型：
--
作者：
El-Boghdadly, K.;Wong, D. J. N.;Ahmad, I.
参与气溶胶生成程序（如气管插管）的医护人员可能会增加感染COVID-19的风险。然而，这种风险的大小尚不清楚。我们进行了一项前瞻性国际多中心队列研究，招募了参与疑似或确诊COVID-19患者气管插管的医护人员。通过自我报告收集有关气管插管事件、个人防护设备使用和随后提供者健康状况的信息。主要终点是实验室确认的COVID-19诊断或气管插管事件后需要自我隔离或住院治疗的新症状的发生率。考克斯回归分析检查了主要终点与医护人员特征、手术相关因素和个人防护设备使用之间的相关性。2020年3月23日至6月2日，来自17个国家503家医院的1718名医护人员报告了5148次气管插管事件。中位（IQR [范围]）32天（18-48 [0-116]）随访期间，主要终点的总体发生率为10.7%。首次气管插管后7、14和21天内的累积发生率分别为3.6%、6.1%和8.5%。主要终点的风险因国家而异，女性较高，但与其他因素无关。约十分之一参与疑似或确诊COVID-19患者气管插管的医护人员随后报告了COVID-19结果。这对提供基本医疗服务的机构能力产生了人力资源影响，并对COVID-19传播产生了更广泛的社会影响。
Healthcare workers involved in aerosol-generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID-19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or confirmed COVID-19. Information on tracheal intubation episodes, personal protective equipment use and subsequent provider health status was collected via self-reporting. The primary endpoint was the incidence of laboratory-confirmed COVID-19 diagnosis or new symptoms requiring self-isolation or hospitalisation after a tracheal intubation episode. Cox regression analysis examined associations between the primary endpoint and healthcare worker characteristics, procedure-related factors and personal protective equipment use. Between 23 March and 2 June 2020, 1718 healthcare workers from 503 hospitals in 17 countries reported 5148 tracheal intubation episodes. The overall incidence of the primary endpoint was 10.7% over a median (IQR [range]) follow-up of 32 (18-48 [0-116]) days. The cumulative incidence within 7, 14 and 21 days of the first tracheal intubation episode was 3.6%, 6.1% and 8.5%, respectively. The risk of the primary endpoint varied by country and was higher in women, but was not associated with other factors. Around 1 in 10 healthcare workers involved in tracheal intubation of patients with suspected or confirmed COVID-19 subsequently reported a COVID-19 outcome. This has human resource implications for institutional capacity to deliver essential healthcare services, and wider societal implications for COVID-19 transmission.