key: cord-0844298-q1up6y2d
authors: Hung, Kuo-Chuan; Chen, I-Wen; Sun, Cheuk-Kwan
title: A safe-distance technique for orotracheal intubation using Trachway intubating stylet in the airborne isolation room
date: 2020-08-14
journal: Anaesthesia Critical Care & Pain Medicine
DOI: 10.1016/j.accpm.2020.04.021
sha: f498b728c77af1152a7329e98f6bea49bf78e6fd
doc_id: 844298
cord_uid: q1up6y2d

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discouraged because not only would it impede airflow but it could also expose themselves to the source of infection [1] .

Tracheal intubation (TI) with mechanical respiratory support is the last resort for patients with respiratory failure. With the global spread of coronavirus disease 2019 (COVID-19), there is an ever-increasing number of patients isolated in NPIRs requiring TI as a life-saving procedure. For HCWs with personal protective equipment (PPE), TI for patients in this particular setting remains a high-risk procedure during which blood, secretions, droplets and aerosols may be widely shed. Besides, positioning themselves behind the patient's head in close proximity to the patient's airway during TI in NPIR further increases the risk of pathogen exposure, knowing that the airflow is directed toward the operator. The limited protection offered by PPE for HCWs has been highlighted by the findings that the current Centers for Disease Control and Prevention (CDC) algorithm is insufficient to protect HCWs from contamination during PPE removal [2, 3] .

With the introduction of a variety of novel videolaryngoscopic devices, TI can be achieved with the operator standing next to the patient to avoid the conventional behind-the-head position [4] . The new-generation Trachway video stylet (Trachway, Markstein Sichtec Medical Corporation, Tai-Chung, Taiwan) consists of a malleable video stylet and a detachable monitor that allows real-time wireless image delivery.

Here, we demonstrated a safe-distance technique for TI using the Trachway intubating stylet (video 1). First, the video monitor was detached and placed on the Because airway management techniques such as bag valve-mask ventilation or TI may cause aerosol spread, rapid sequence induction is recommended for patients infected with COVID-19 [5] . Our experience with the general population showed that the safe-distance TI technique can be successfully performed within 30 seconds in experienced hands. We suggest that this technique may be considered when tracheal intubation is required in the negative pressure isolation room for patients with potential or confirmed COVID-19 infection.

No external funding and no conflicts of interest declared J o u r n a l P r e -p r o o f

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