key: cord-1037038-solxq2mt
authors: Yang, Stephen S.; Zhang, Michelle; Chong, Jaron J.R.
title: Comparison of three tracheal intubation methods for reducing droplet spread for use in COVID-19 patients
date: 2020-05-11
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.04.083
sha: d46bddb5a79a72fbfd2f498c9d3013d646e7441c
doc_id: 1037038
cord_uid: solxq2mt

nan

connector tubing to a 10 ml syringe containing a red-dye solution. The first test with direct 1 laryngoscopy showed a large amount of dye on the laryngoscopist's faceshield, gown, arms, 2 glove, neck and hair. The second test with the videolaryngoscopy technique showed significantly 3 lower amount of dye on the laryngoscopist in similar locations, visually less than half the 4 quantity compared to direct laryngoscopy. The third test with videolaryngoscopy and the box 5 showed dye only on the gloves and forearms within the box; no dye was visible on any part of 6 the laryngoscopist located outside the box including gown, face shield, neck and hair (Fig. 1) . 7 8 Our simulation method is one of the few simulation to show both large and small droplet 9

trajectory. In the video, it is interesting to note that microdroplets lingered longer. Out of the 10 three methods, videolaryngoscopy, as compared to direct laryngoscopy, was the preferred 11 method of tracheal intubation given the significant decrease in the amount of aerosolized 12 droplets on the laryngoscopist. The box offered an additional physical barrier as compared to 13 videolaryngoscopy. However, we believe that with proper personal protection equipment, there 14 is minimal additional benefit in terms of droplet protection. Our technique measured droplet 15 spread primarily, and my be less sensitive to fine aerosols. A potential disadvantage of the box is 16 the restriction to movement and adapting to a new way of intubation. In the event that the airway 17 proves to be difficult, the box should be immediately abandoned. 18

19

The authors declare that they have no conflicts of interest 21

coronavirus: what anaesthetists should know

Aerosol generating procedures and 5 risk of transmission of acute respiratory infections to healthcare workers: a systematic review

Anaesthesia and COVID-19: infection control

Hoogenboom, and others 10 4 Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan

China: lessons learnt and international expert recommendations

Taiwanese doctor invents device to protect US doctors against coronavirus

Supplementary data related to this article can be found online