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