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Table 3 Recommendations for intubation and transport of a suspected/known COVID-19 patient

From: Preparing your intensive care unit for the COVID-19 pandemic: practical considerations and strategies

  Optimise patient safety Infection prevention and control
Preparation Early identification of patients requiring intubation [35]
Formulate airway plans A, B, C, D
Don PPE with airborne precautions
Prepare all equipment for intubation
• Airway
• Breathing devices, e.g. bag-valve-mask device
• Breathing circuit
*Intubate within an AIIR [17, 36]
PPE and airborne precautions for all staff [17, 36]
HEPA filter to reduce circuit and environmental contamination (Fig. 2a)
Intubation Preoxygenation for 5 min, with ‘head-up’ positioning when possible
Consider PEEP valve with bag-valve-mask pre-oxygenation
Consider nasal cannula (15 L/min) for apnoeic oxygenation
Intubation by the most experienced operator
Use video laryngoscope to optimise view through PAPR or goggles
Ensure good mask seal
Avoid HFNC for pre-oxygenation
Rapid sequence induction—minimise need for face mask ventilation [35]
Small tidal volumes if ventilation unavoidable [35]
Ensure full paralysis to reduce coughing [35]
Post-intubation Confirm tracheal tube position with capnography (difficult auscultation with hooded PAPR) Positive pressure ventilation to be initiated only after cuff is inflated
Sedation and paralysis to reduce coughing
Transport of the intubated patient Consider if transport is necessary
Sedation and paralysis to reduce risk of coughing or inadvertent self extubation
HEPA filters for circuit and transport ventilator (Fig. 2)
Place ventilators on standby mode and clamp tracheal tube for the period of disconnection [36]
Adhere to a designated route with minimal contamination and exposure to other clinical areas
  1. COVID-19 coronavirus disease 2019, PPE personal protective equipment, PEEP positive end expiratory pressure, PAPR powered air-purifying respirator, AIIR airborne infection isolation room, HFNC high-flow nasal cannula, HEPA high-efficiency particulate air
  2. *Intubation should ideally be performed in an AIIR for suspected or known COVID-19 patients