COVID-19: hoodwinked? The view from the other side of the mask
The below letter will be published in May's issue of Anaesthesia News
As the hospital Trust serving the region at the centre of the UK’s cluster of COVID-19 cases, it is fair to say that the management of these patients has generated a great deal of discussion within our anaesthetic department. In a recent study of 138 hospitalised patients, 17 (12.3%) of patients required invasive lung ventilation, and hospital related transmission was suspected in 51 (41%) cases including 40 (29%) healthcare workers .
There had been much speculation that use of full-face visors such as those found on the 3M Scott FH1 Half Hood Headtop powered air respirator (PAPR) used in our own trust would impair laryngoscopic view during tracheal intubation. We therefore set up a session for trainee anaesthetists with two aims: familiarisation with the PAPR; and practice intubation of a manikin using direct and C-MAC videolaryngoscopy whilst wearing the PAPR.
Trainees whose beards preclude the use of an FFP3 mask were particularly keen to try the PAPR. Informal feedback suggested operators did not find that using the PAPR impaired their ability to obtain a satisfactory view at direct laryngoscopy. However it was felt that videolaryngoscopy might still be a sensible choice, as it increased the distance between the intubator’s face and the patient during this aerosol-generating procedure (Figures 1 and 2).
WHO, NHS and Trust policy regarding COVID-19 is a rapidly evolving field. Our discussions were not intended to agree a definitive Standard Operating Procedure, but to give an opportunity for individuals to consider the issues they might encounter. This is likely to be relevant to future pandemics.
We would encourage all anaesthetists to consider similar training and discussion.
Katherine Hunter, ST6 Anaesthetics, Royal Sussex County Hospital
Sandeep Sudan, Consultant Anaesthetist, Royal Sussex County Hospital
Richard Stoddart, Consultant Anaesthetist, Royal Sussex County Hospital
1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Journal of the American Medical Association 2020; published online doi:10.1001/jama.2020.1585.