A disposable envelope for video-assisted intubating stylet during tracheal intubation in COVID-19 pandemic.

Abstract

DEAR EDITOR, Tracheal intubation of patients with coronavirus disease-19 (COVID-19) is a potentially aerosol-generating procedure that requires a careful and efficient approach to ensure the safety of both patients and healthcare providers.1 Many guidelines recommend the use of video-assisted intubating devices (VAIDs) to increase the operator’s distance from the patient’s airway and the chance of first-pass success.2 When donned with personal protective equipment (PPE), the first-pass success rate and intubation time with VAIDs are not affected when compared with a direct laryngoscope.3 A VAID is usually a video laryngoscope or video intubating stylet. It mainly composes of four parts: monitor, main body, handle and its cable, and a blade or stylet. Compared with the traditional direct laryngoscope, VAIDs can be expensive to use and maintain with concerns for cost-effectiveness, quality, and environmental impact from the disposable blades or stylets. Moreover, the nondisposable parts of the equipment such as the handle, cable, and main body can be potential sources of cross-contamination if strict decontamination is not followed.4 An innovative and economic approach is to cover the entire VAID device with a disposable envelope, including the optic stylet, handle, and monitor during airway management. We explored this concept using a video optic intubating stylet (disposcope endoscope). An elastic, flexible heat-shrunk tube was designed and manufactured, which the optic style can be inserted easily without any lubricant. The end tip of the heat-shrunk tube consists of a transparent acrylic lens that does not block or in any way compromise the light and camera of the optic stylet. The handle is then covered by a disposable plastic drape. This setup ensures the video optic stylet is fully shielded during airway management or tracheal intubation. The demonstration is provided by supplementary appendix (https://youtu.be/XBh1W5Rki8k). After each procedure, the heat-shrunk tube and the plastic handle drape can be removed and disposed of. The heat-shrunk tube is very thin (thickness in 1.5 mm). After its fitting over the optic stylet, it still allows the loading of endotracheal tube equal to or larger than 5.5 ID in size. A pediatric optic stylet with a matching heat-shrunk tube is also developed, and it can be loaded with an endotracheal tube equal to or larger than 3 ID in size. The COVID-19 pandemic is not likely going to disappear and can potentially become a seasonal or endemic foe. Furthermore, infected asymptomatic and mildly symptomatic still confer a high risk of transmission. Routine and emergent airway management thus poses the risk of potential exposure and infection to healthcare workers during the procedure and postoperative decontamination.5 An affordable and practical disposable barrier method to the video-assisted airway device to protect the operators and reduce the associated cost.