DEAR EDITOR,

During the outbreak of coronavirus disease 2019 (COVID-19) pandemic, frontline health-care worker are at high risk of contamination and spreading the infection. Especially, anesthesiologists, intensivists, and other members of the airway management team should be careful when performing tracheal intubation for patients with COVID-19.1 The use of video-assisted intubating devices (VAIDs) for tracheal intubation is highly recommended due to the increasing distance between patient’s airway and operator.2

Fortunately, after 3 years combat with this pandemic (2019 December–2022 December), the hospitals gradually overcame this challenge and made important adjustments in airway management, the authors observed two important changes and considered worth be addressed.

First, VAID will replace the position of traditional direct laryngoscope (DL) in airway management. VAID has growing acceptance because the enhanced visual field makes intubation will be easier and successful on the first try.3 It made the whole procedure safer for operators compared with traditional DL. Furthermore, VAID reduces the risk of spreading a highly contagious virus. That’s good news for emergency and intensive care unit (ICU) doctors, who typically perform fewer routine intubations than anesthesiologists. The VAID is also safer for physicians dealing with COVID-19 because they don’t have to get as close to the patients far as the do with a DL.4 It’s safer for patients too, because it results in fewer injures.

We designed and conducted a simple survey. We asked the questions relevant to the availability of VAIDs in anesthetic department, emergent room, and ICU in each hospital. Whether or not they had and used VAIDs before the pandemic (2019 December) and at the present time (2022 December)? The surveys were distributed to 17 medical centers and 65 regional hospitals in Taiwan. In total 51 (62%) forms were returned. The result (Fig. 1) showed that the anesthetic department was already fully equipped with VAIDs before the pandemic, but only 69% of emergent room and 31% of ICUs equipped with VAIDs. However, due to the impact of COVID-19 pandemic, the VAIDs were equipped to a greater extent in emergent room (94%) and ICUs (71%). We find the transition to VAIDs as a routine first-line option throughout anesthetic department, emergency room, and ICU in airway management. We suggest that all patients with COVID-19, and ideally every patient during the pandemic should be intubated using VAIDs.

Fig. 1:

The availability of video-assisted intubating devices (VAIDs) in anesthetic department (Anes.), emergency room (ER), and intensive care units (ICU) before (2019 December) and after (2022 December) the coronavirus disease 2019 (COVID-19) pandemic. N = 51.

Second, the use of single use, disposable intubating blades or envelopes was broadly adopted. A VAID is usually a video laryngoscope or video intubating stylet. Compared with the DL, VAIDs can be expensive to use and maintain with concerns for cost-effectiveness. Thus we precious innovated an economic disposable envelops for video intubating stylet.5 Now the envelopes or disposable blades are routinely used broadly during airway management for COVID-19 patients.

The COVID-19 pandemic brought the VAIDs increasing into pandemic in mind; VAIDs are a safer and more efficient equipment to use in critically ill patients, where timely intubation can be lifesaving. It is possible that airway management will have been changed forever with COVID-19 pandemic. We should not miss the opportunity to embrace this new pandemic influenced role on the use of VAIDs and to implement its use as a routine intubation device for all patients.

REFERENCES 1. Tseng JY, Lai HY. Protecting against COVID-19 aerosol infection during intubation. J Chin Med Assoc 2020;83:582. 2. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020;75:785–99. 3. Raithel S, Fields KG, Wu Y, Yao D. Adoption of airway management guidelines during COVID-19 pandemic improved endotracheal intubation success. J Clin Anesth 2021;76:110556. 4. Tseng JY, Hsu SH, Lai HY. Disposable protective barrier enclosure prevent aerosol contamination during aerosol-generating procedures. J Chin Med Assoc 2021;84:119–20. 5. Tseng JY, Hsu SH, Lai HY. A disposable envelope for video-assisted intubating stylet during tracheal intubation in COVID-19 pandemic. J Chin Med Assoc 2022;85:136.