Abstract
The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has magnified the risk to healthcare providers when inititiating airway management, and safe tracheal intubation has become of paramount importance. Mitigation of risk to frontline providers requires airway management to be an orchestrated exercise based on training and purposeful simulation. Role allocation and closed-loop communication form the foundation of this exercise. We describe a methodical, 10-step approach from decision-making and meticulous drug and equipment choices to donning of personal protective equipment, and procedural concerns. This bundled approach will help reduce unplanned actions, which in turn may reduce the risk of aerosol transmission during airway management in resource-limited settings.
Highlights
The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, pandemic has brought infections that are transmitted via droplet and aerosol under the spotlight.[1]
We describe a step-by-step approach to endotracheal intubation of critically ill patients with suspected or confirmed COVID-19 and other airborne diseases with the goal of limiting the risk of exposure to healthcare providers
Review the equipment required for intubation (Figure 1A) (Table 2); the registered nurse (RN) loads pre-calculated doses of Rapid sequence intubation (RSI) medications (Table 3)
Summary
The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, pandemic has brought infections that are transmitted via droplet and aerosol under the spotlight.[1]. Rapid sequence intubation (RSI) and invasive mechanical ventilation are preferred. Non-invasive positive pressure ventilation (NIPPV) increases the risk of aerosol generation; NIPPV has been associated wth increased risk of healthcare worker infection and should be avoided.[4,5,6 2]. STEPS OF MIST (Modified Intubating Sequence for Transmissibility) BUNDLE 1. Review patient clinical data to determine appropriateness of endotracheal intubation and mechanical ventilation for the patient. 2. Preparatory phase – Cold Zone Step a. Use continous positive airway pressure mode with non-invasive ventilation (NIV) mask for preoxygenation. Review the equipment required for intubation (Figure 1A) (Table 2); the registered nurse (RN) loads pre-calculated doses of RSI medications (Table 3). The assembly (Figure 1B) of the endotracheal tube (ETT) should be preset with a catheter mount containing a viral filter, and an inflation syringe with an intubating bougie
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