Thread by @srrezaie

Airway management recs from Hong Kong on #COVID19

Aerosol generating procedures, such as NIV, HFNC, BMV, & intubation all high-risk

≥6L/min of O2 are considered high flow & use should be discouraged if airborne isolation room unavailable

ncbi.nlm.nih.gov/pubmed/32105633 #COVID19FOAM

In pts with suspected COVID-19, airborne precautions, hand hygiene, & donning of PPE is recommended

Double gloving, as standard practice might provide extra protection & minimize spreading via fomite contamination to surrounding equipment after intubation

Have a backup airway plan ready to go prior to intubation

Most skilled person at intubation should perform the procedure to minimize attempts

BVM prior to intubation generally should not be used (Could use viral exhalation filter between BVM)

If BVM required, use gentle ventilation via SGA instead of BMV

No robust evidence shows SGAs are less aerosol-generating than BVM but easy to place & reduce staff exposure

RSI is tx of choice for intubation (Inadequate sedation/paralyzation can produce coughing during laryngoscopy which can also generate aerosols

Roc 1 - 2mg/kg IV has similar onset as sux, but because of longer half-life, prevents coughing or vomiting that can occur with sux

VL recommended over DL with a display separate from the blade to avoid placing the face of the intubator close to the patient