Endotracheal Intubation in High-Risk Infections

Abstract

Airway manipulation in high-risk infections poses significant threat to intensivists and anaesthesiologists. Proper precautions at the patient’s or the healthcare provider’s end with environmental modifications in the intensive care unit or operation theatre design are vital to prevent spread of infections. Pre-oxygenation should avoid positive pressure and cough and gag reflexes should be blunted by medicines before manipulating the airway. Use of personal protective equipment is a must and crash intubation should always be avoided. Airway management should be preferably be done by most experienced of the team and use of video laryngoscopes or video-assisted intubating stylets are suggested to minimise the proximity of airway handler to patient’s face. Tube position confirmation should be by end-tidal capnography and auscultation should be avoided. Filters and closed suction should be used. Use of intubation boxes, plastic drapes or tents, negative airflow tents have been described for aerosol containment. All aerosol-generating procedures should ideally be performed in negative pressure (<−5 Pa) isolation rooms having at least 12 air exchanges per hour. Biomedical waste generated during intubation should be optimally disposed. Following proper protocols may help to minimise the chances of airway handler getting infected. However, regular review of protocols based on staff’s feedback is vital for continuous quality improvement.