Emerging Perspectives of Endotracheal Intubation in Patients with Severe COVID- 19 Pneumonia: A Narrative Review

Abstract

The coronavirus disease 2019 (COVID -19) pandemic that has engulfed the world has put an immense strain on the existing healthcare systems. The rapid, insidious and often dramatic deterioration of the respiratory function of an infected patient, has led to an increased need for effective and rapid airway control. However, such airway control techniques put the healthcare workers to an increased risk of exposure to the virus. Therefore, interventions aimed at minimising such risks, while preventing the complications inherent to securing an airway are imperative to the management of a COVID-19 patient in acute respiratory failure (ARF). Personal protective equipment (PPE) is sine qua non to keep the intubator safe, however some barrier equipment’s have been employed with limited success. There are varied schools of thought on whether to intubate early or late, and the use of non-invasive methods for management of respiratory failure, however, most consensus statements reinforce the need for rapid sequence induction (RSI), which provides ideal intubating environment for an experienced intubator. Techniques, which decrease the number of required personnel as well as time, to secure the airway and increase the distance of the intubating physician from the patient, are recommended. Routine use of, videolaryngoscope, if available, is recommended. While intubation with an endotracheal tube is the gold standard airway technique, second generation supraglottic airway devices (SAD) are increasingly being recommended, particularly in cases of failure to intubate or in an unanticipated difficult airway. Awake intubation techniques are contraindicated due to increased risk of cough and subsequent aerosolization; however, few modifications were innovated when if it all required. In this review, we summarise the existing data with respect to the modifications and guidelines in severe COVID-19 patients who requires endotracheal intubation for invasive mechanical ventilatory support.