Page 18 - CASA Bulletin of Anesthesiology 2020 Issue 2

CASA Bulletin of Anesthesiology

Intubation Procedure on a COVID-19 Patient

Steven Chen, MD

Long Island Anesthesia physicians
March 19, 2020

I was called by the intensivist for an semi-elective intubation on a COVID 19 patient. Patient was a 67
year-old male, PMHx of COPD, without home-O2, HTN, no other traveling history . He came to the hospital
four days prior for worsening coughing, fever and SOB . Flu and RSV swabs were negative . COVID 19 swab
was pending at the time of intubation . However, his CT chest showed B/L ground glass appearance, which is
highly likely to be COVID 19 .

When I received the call, patient had stable VS. He was on 100% NRM, no signs of respiratory distress.
However, his ABG had shown his respiratory status was deteriorating. After explaining the risk and benefit to
the patient, the intensivist and the patient decided that early intubation should be performed while patient was
still stable .

For PPE, I took the Stryker T4 helmet and Stackhouse FreedomAire (normally known as the space suit
for joint replacement), surgical gown, with double surgical gloves, N95 and a surgical mask on top of N95 (to
keep N95 clean and reuse), goggles. The space suit is used to prevent droplets during the proximity during
the procedure. Furthermore I went to the ICU with another anesthesiologist, for potential difficulty.

My nurse helped me put on my space suit outside of the isolation room, with my hood fan setting to low .
I examined the patient as I entered the room. His VS was stable, O2 sat was 100% on NRM, without signs of
respiratory distress . His airway is Mallipattie I, with a good thyromental distance . Inside the isolation room, I
had the ICU nurse and a respiratory therapist to assist me. My fellow anesthesiologist was immediately avail-
able outside of the patient room to conserve PPE .

After sufficient pre-oxygenation with 100% O2, a rapid sequence intubation was performed with 120
mg Propofol and 100 mg Succinylcholine. Laryngoscopy was performed with Glidescope (as planned), and
Grade I view. A size 8.0 endotracheal tube was passed without resistance. After confirming end tidal CO2, the
ETT was secured by the respiratory therapist .

After the procedure, in the corner of the room, I carefully took off the outside glove first, followed by
taking off my surgical gown from behind, keeping the front chest part of the gown away from myself . Then, I
took the cover of my Stryker helmet off, and kept the side which faced to the patient away from self . Finally,
I took off my Stryker helmet, and sprayed it down with the sanitizer, provided by ICU and left the room. The
entire duration of my stay in the room was around 10 minutes .

There was a suggestion that keeping the fan inside of the Stryker helmet off . It prevents entraining “dirty
air from the isolation room” to the operator’s gown and helmet . However, the issue is that without fan circu-
lation, moisture and vapor quickly build on the shield and block the visualization even for a very brief period
of time . Therefore, I kept the fan setting on low, and wore N95 mask under the hood with goggles .

As the COVID 19 situation getting worse, our supply of PPE is running low . Anyone has a better sugges-
tion?
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