Author: Chris Nickson
The Alfred ICU Guideline for Intubation of Critically Ill Patients has recently been updated with an Appendix outlining modifications for suspected COVID19 patients. The attractive design of the guideline reflects great work by Dr Julia Coull (@julia_coull). The content of the Appendix on COVID19 has been heavily informed by the input of multiple Alfred ICU staff from COVID19 intubation simulations and real life intubations of suspected COVID19 patients, as well as the existing literature. The final content of the Appendix was determined by A/Prof Steve McGloughlin (ICU Director), Dr Julia Coull, and me (A/Prof Chris Nickson). The guideline itself is largely based on a modified adaptation of the DAS guidelines by Higgs et al (2018) for local use in our context.
Higgs A, Mcgrath BA, Goddard C, et al. Guidelines for the management of tracheal intubation in critically ill adults. Br J Anaesth. 2018;120(2):323-352. [article]
Just a thought- to conserve resources wouldn’t it be better to keep the spare equipment just outside the room ready rather than having to chuck all the disposable equipment out after every patient?
If equipment for Plan B-D is outside the room it will need to be brought into the room by someone wearing PPE in the event of an emergency.
This will increase the number of staff exposed to COVID19 during a potentially aerosol generating procedure.
It will lead to delays in airway management issues being addressed, and risk patient harm or death as these patients will be critically ill with hypoxaemia (which may rapidly become life-threatening).
We believe the safest option is to have the required equipment for Plans B-D set up and ready to use immediately.