ABSTRACT
Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. In particular, doffing requires strict protocol adherence to avoid exposure. We describe the Emory Healthcare intubation team approach during the COVID-19 pandemic. This structure resulted in only 1 team member testing positive for COVID-19 despite 253 patient intubations over a 6-week period with 153 anesthesia providers on service.
Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intubation, Intratracheal/adverse effects , Occupational Exposure/prevention & control , Occupational Health , Patient Care Team , Pneumonia, Viral/therapy , COVID-19 , Checklist , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Decontamination , Equipment Contamination/prevention & control , Humans , Intubation, Intratracheal/instrumentation , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Risk Assessment , Risk Factors , SARS-CoV-2Subject(s)
Coronavirus Infections/prevention & control , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Operating Rooms , Organizational Innovation , Pandemics/prevention & control , Patient Care Team/organization & administration , Pneumonia, Viral/prevention & control , Simulation Training , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Georgia/epidemiology , Humans , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Quality Improvement , SARS-CoV-2Subject(s)
Intubation, Intratracheal/methods , Laryngoscopy , Obesity , Point-of-Care Systems , Humans , PostureABSTRACT
BACKGROUND: The effect of patient position on the view obtained during laryngoscopy was investigated. METHODS: 60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the patient's head, thus raising the occiput a standard distance from the operating-table while the patient remained supine. In Group 2, a "ramped" position was achieved by arranging blankets underneath the patient's upper body and head until horizontal alignment was achieved between the external auditory meatus and the sternal notch. Following induction of general anesthesia, tracheal intubation was performed using a Video MacIntosh laryngoscope. The laryngoscopy and intubation sequences were recorded onto videotape. Three independent investigators, unaware as to which position the patient had been in at the time of tracheal intubation, then viewed the videotape and assigned a numerical grade to the best laryngeal view obtained. RESULTS: The "ramped" position improved the laryngeal view when compared to a standard "sniff" position, and this difference was statistically significant (P=0.037). CONCLUSION: The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.
