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Practical Guidance for Tracheal Intubation of Patients With COVID-19

      The novel coronavirus (COVID-19) pandemic has created an urgent need for pragmatic best-practice approaches that maximize safety for both patients and care providers during the tracheal intubation of patients who are suspected or confirmed to be infected. Literature reporting experiences during the severe acute respiratory syndrome (SARS) epidemic revealed that providers who engaged in tracheal intubation had a substantial increase in risk of viral transmission.
      • Raboud J.
      • Shigayeva A.
      • McGeer A.
      • et al.
      Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.
      • Tran K.
      • Cimon K.
      • Severn M.
      • et al.
      Aerosol-generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.
      • Esquinas A.
      • Pravinkumar S.
      • Scala R.
      • et al.
      Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review.
      Longstanding principles of emergency airway management, including excellent preoxygenation and rapid sequence intubation techniques, apply to patients with suspected or confirmed COVID-19 infection. However, some accepted and common practices may also substantially increase the risks to health care providers in this setting: Specifically, droplet generation and aerosol generation before, during, and after tracheal intubation creates risk for the proceduralist.
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