key: cord-0822751-bxapqnmh
authors: Miller, Lydia; Luković, Elvedin; Wagener, Gebhard
title: Guiding airway management and PPE for COVID-19 intubating teams
date: 2020-06-06
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.06.001
sha: 0a03ddd40f2d3eb308cb2c4b961bf88b3c7cc8f9
doc_id: 822751
cord_uid: bxapqnmh

nan

Center for Disease Control (CDC) PPE recommendations for aerosol-generating procedures in COVID-19 patients. 2 Table 1 . COVID-19 Bag Inventory N95 mask respirators: regular and small sizes Disposable waterproof gowns for intubating provider and airway assistant Disposable non-waterproof gowns for providers not directly involved in airway management Head covering: Bouffant or head/neck wrap Eye/face protection: Welder-style facemask or surgical mask with face-shield attached Sterile surgical gloves* HEPA filter † Small plastic bags ‡ * For double gloving including one pair of sterile surgical gloves because their longer cuffs provide better wrist protection. The top layer should be removed immediately after intubation. † Placed on the expiratory limb of a ventilator or between the endotracheal tube and self-inflating bag ‡ After the McGrath ® videolaryngoscope handle is cleaned with bleach or alcohol-based wipes it is handed to an assistant outside of the patient room, cleaned again, and placed in a plastic bag.

Guidelines for tracheal intubation. Our guidelines are based on reports from the SARS-CoV-1 outbreak and recommendations from the Anesthesia Patient Safety Foundation. [3] [4] [5] The main objective is to reduce the risk of aerosolization during intubation by: 

• Ensuring adequate sedation post-intubation. A substantial number of patients in non-ICU settings self-extubated shortly after intubation. In response, the department developed a sedation protocol that included administration of a midazolam bolus and initiation of a propofol infusion immediately after intubation.

• Post-intubation haemodynamic instability. Our surgery colleagues created procedure teams that rapidly placed arterial and central lines for monitoring and infusions of vasoactive drugs following intubation. 8

• Restocking supplies as demand escalates. At the beginning of the crisis we purchased our own bags and stocked them using supplies from the operating room and the ICUs.

When the number of intubations escalated rapidly, the hospital created a supply chain for ordering supplies and assembling the COVID-19 bags.

We strongly recommend that hospitals create a plan to ensure their intubation teams have access to appropriate PPE and airway protocols for COVID-19 patients before a crisis develops. Our airway management guidelines and COVID-19 bags were invaluable as the number of intubations rapidly accelerated. Importantly, hospitals must be prepared to modify their airway management and PPE guidelines based on feedback from clinicians on the ground and improved understanding of the transmissibility of the virus.

Critical care lessons from severe acute respiratory syndrome

Anaesthesia and SARS

Outbreak of a new coronavirus: what anaesthetists should know

Barrier Enclosure during Endotracheal Intubation

None of the authors have a conflict of interest with regard to this manuscript.