COVID 19 patients intubation

What is the process and equipments to intubate COVID19 patients the best way to prevent the spread.

That is a very fluid topic at the moment. the following are just suggestions, some of them not evidence based

FROM SSCM guidelines

  • First we need to recognize that full PPE (N95 or PAPR, eye protection, gowns and gloves ) and adequate technique for donning and doffing are the most important aspects to prevent spread.
  • Second minimized the number of people in the room.
  • Third, most experienced provider available should intubate.
  • Forth, perform procedure in a negative pressure room.

After all of that, lets talk about equipment (other than PPE and actual procedure). This gets bit more complicated

Equipment (it will depend on what is available at your institution and what you are comfortable using)

  1. Viral/Bacterial Filter
  2. PPEs
  3. Non rebreather or Adult BVM
  4. PEEP valve (will be attach to the Adult BVM to avoid air leaks
  5. End Tidal CO2 ETT adaptor (will be place post viral filter)
  6. End Tidal CO2 tubing monitor
  7. Video-guided Laryngoscope for VL (preferred method) if available if not Miller or Mac blades and handles for DL

Procedure

  1. Preoxygenation, prolonged >= 5 min if possible. avoid bagging if possible. If bagging is needed use two hands to provide a good seal, use viral/bacterial filter and small tidal volume
  2. Do it using RSI, avoid coughing as much as possible, use adequate dose of paralytics
  3. VL will help to keep a good distance between airway operator and patient
  4. inflate cuff immediately after intubation

Post intubation

  1. attach ETT to vent, I would recommend to avoid using stethoscope to check for ETT placement unless high concern for right main intubation
  2. Confirm ETT placement by CO2 sampling and vent peak and plateau pressures
  3. Doffing adequately is extremely important

here some links that are very useful, again with suggestions some of then not evidence based

https://www.utmb.edu/covid-19/health-care-workers/don-and-doff-ppe




https://www.cuimc.columbia.edu/file/44538/download?token=luHx0iV_

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Great technique, thank you

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