The suggested management of endotracheal intubation in a patient infected with or suspected of SARS-CoV-2 infection

Dear Editor,
I have read with great interest the paper by Wujtewicz et al. [1] on what anaesthetists should know about SARS-CoV-2 infection.
The airway management guidelines for endotracheal intubation presented in the above study (Table 2) are extremely important for anaesthetists. The tracheal intubation of a patient infected with SARS-CoV-2 is one of the procedures posing the greatest threat to those performing it due to the aerosol generated during the procedure. To ensure the safety of patients and the personnel involved, the procedure should be standardised; therefore, I suggest that it should be described in detail. I present below a collection of recommendations based on available literature. To reduce the risk of exposure of the medical staff performing the procedure, several different measures ought to be taken:
– an intubation kit containing the endotracheal tubes of at least four sizes (7–8 for women and 8–9 for men) should be prepared; it is recom­mended to use the endotracheal tubes with subglottic suctioning, second generation supraglottic devices, face masks, oropharyngeal tubes, short intubation stylet and long Bougie, Magille’s forceps, Pean’s forceps, and suctioning tubes;
– appropriate personal protective equipment should be used while working in close proximity to the patient infected with SARS-CoV-2;
– it is advisable to use additional barriers protecting from aerosol spread during the procedure, e.g. covering the patient’s headrest with a transparent foil;
– the patient should wear a face mask until the procedure is initiated;
– preoxygenation should be carried out using a tightly applied, two-handed grip face mask; a VE (not CE) grip is recommended to maintain maximum tightness;
– preoxygenation should be carried out using the lowest effective oxygen flow;
– preoxygenation should be reduced to a minimum: 3–5 minutes only in patients expected to have short safe apnoea times due to their general condition;
– high-flow nasal oxygen therapy or continuous positive airway pressure is not recommended for preoxygena­tion;
– care should be taken to ensure that the patient is properly positioned for intubation; in obese patients, in particular, it is essential to raise – the headrest to increase the effectiveness of preoxygenation and to improve the conditions for performing laryngoscopy;
– the number of staff members performing intubation should be reduced to a...


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