Airway Management Strategies for COVID-19 Patients

Airway management in patients with COVID-19 has evolved rapidly to balance the imperative of securing the airway with the need to protect healthcare workers from viral transmission. Strategies encompass pre-intubation assessment, minimisation of aerosol generation, choice of airway devices, enhanced personal protective equipment (PPE), and post-procedure care. Key principles include the use of rapid-sequence induction to avoid bag-mask ventilation where feasible, video laryngoscopy to increase distance between operator and patient, and the application of barrier enclosures or drapes to intercept aerosols. Team preparedness, standardised protocols and frequent simulation training underpin safe practice. Ventilation strategies in the intensive care unit (ICU) emphasise closed-circuit systems, the implementation of negative-pressure rooms, and judicious timing of extubation to reduce coughing events. The global response has highlighted the interplay between engineering controls, PPE innovation and procedural modifications to maintain both patient safety and provider well-being.

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Airway Management Strategies for COVID-19 Patients publication trend

The graph below shows the total number of articles in airway management strategies for covid-19 patients across all publications each year (not limited to Nature Index journals).

Technical terms

Aerosol-generating procedure (AGP): A clinical intervention, such as tracheal intubation or bronchoscopy, that produces airborne particles capable of transmitting respiratory pathogens.

Computational fluid dynamics (CFD): A modelling technique used to simulate airflow and particle dispersion for optimising device design.

Negative pressure environment: A setting in which air flows into, but not out of, an enclosed space to contain airborne contaminants.

Powered air-purifying respirator (PAPR): A battery-powered device that delivers filtered air through a hood or mask to protect the wearer from inhaling hazardous aerosols.

Intubation enclosure: A barrier device designed to shield healthcare workers from aerosolised particles during airway manipulation.

References

1. Enhancing Aerosol Mitigation in Medical Procedures: A CFD-Informed Respiratory Barrier Enclosure. Bioengineering (2024).
2. COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study. Emergency Medicine Journal (2020).
3. Use of powered air-purifying respirator (PAPR) by healthcare workers for preventing highly infectious viral diseases—a systematic review of evidence. Systematic Reviews (2020).
4. In-hospital airway management of COVID-19 patients. Critical Care (2020).
5. Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Annals of Intensive Care (2020).
6. Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesthesia Critical Care & Pain Medicine (2020).