In pandemic times, medical staff is becoming a key resource in fighting the infection. To achieve the best medical care, relevant techniques and procedures have to be taught to medical staff to reduce the risk of infection. COVID patients often need mechanical ventilation due to progredient respiratory insufficiency, so an endotracheal intubation becomes a critical procedure in managing these patients. This procedure has an increased risk of infection due to aerosol formation and working with an unsecured airway. Patient safety should not be neglected, and complications like hypoxaemia and aspiration should be avoided. At the same time, personal protection from infection is of utmost importance becuase human resources in a pandemic crisis must be preserved. This video shows the procedure of endotracheal intubation while taking personal infection protection into account.
The key objectives of this protocol are reduction of aerosol formation and rapid sequence induction.
There are several critical recommendations for this protocol: Hold a low threshold for early intubation, use video laryngoscopy in the first line, avoid high-flow oxygen-therapy to reduce aerosol formation, have as few personnel as possible in the room, and use checklists for preparation and procedure.
In case of an unexpectedly difficult airway, supraglottic airway devices are preferred over mask ventilation due to lower risk of aerosol formation. All necessary material needed for a difficult airway should be placed outside the contaminated area and quick access to an additional assistant must be ensured.
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