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The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times.
Otolaryngol Head Neck Surg. 2020 11; 163(5):934-937.OH

Abstract

The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA.Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA.Department of Otolaryngology, University of Perugia, Perugia, Italy.Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA.Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32571147

Citation

Smith, Joshua D., et al. "The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 163, no. 5, 2020, pp. 934-937.
Smith JD, Chen MM, Balakrishnan K, et al. The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. Otolaryngol Head Neck Surg. 2020;163(5):934-937.
Smith, J. D., Chen, M. M., Balakrishnan, K., Sidell, D. R., di Stadio, A., Schechtman, S. A., Brody, R. M., Kupfer, R. A., Rassekh, C. H., & Brenner, M. J. (2020). The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 163(5), 934-937. https://doi.org/10.1177/0194599820936615
Smith JD, et al. The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. Otolaryngol Head Neck Surg. 2020;163(5):934-937. PubMed PMID: 32571147.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Difficult Airway and Aerosol-Generating Procedures in COVID-19: Timeless Principles for Uncertain Times. AU - Smith,Joshua D, AU - Chen,Michelle M, AU - Balakrishnan,Karthik, AU - Sidell,Douglas R, AU - di Stadio,Arianna, AU - Schechtman,Samuel A, AU - Brody,Robert M, AU - Kupfer,Robbi A, AU - Rassekh,Christopher H, AU - Brenner,Michael J, Y1 - 2020/06/23/ PY - 2020/6/24/pubmed PY - 2020/11/18/medline PY - 2020/6/24/entrez KW - COVID-19 KW - SARS-CoV-2 KW - aerosol-generating procedures KW - coronavirus KW - difficult airway KW - flexible fiberoptic laryngoscopy KW - intubation KW - laryngotracheal stenosis KW - novel coronavirus KW - pandemic KW - subglottic stenosis KW - tracheal stenosis KW - ultrasound SP - 934 EP - 937 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 163 IS - 5 N2 - The impact of the COVID-19 pandemic on otolaryngology practice is nowhere more evident than in acute airway management. Considerations of preventing SARS-CoV-2 transmission, conserving personal protective equipment, and prioritizing care delivery based on acuity have dictated clinical decision making in the acute phase of the pandemic. With transition to a more chronic state of pandemic, heightened vigilance is necessary to recognize how deferral of care in patients with tenuous airways and COVID-19 infection may lead to acute airway compromise. Furthermore, it is critical to respect the continuing importance of flexible laryngoscopy in diagnosis. Safely managing airways during the pandemic requires thoughtful multidisciplinary planning. Teams should consider trade-offs among aerosol-generating procedures involving direct laryngoscopy, supraglottic airway use, fiberoptic intubation, and tracheostomy. We share clinical cases that illustrate enduring principles of acute airway management. As algorithms evolve, time-honored approaches for diagnosis and management of acute airway pathology remain essential in ensuring patient safety. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/32571147/The_Difficult_Airway_and_Aerosol_Generating_Procedures_in_COVID_19:_Timeless_Principles_for_Uncertain_Times_ L2 - https://journals.sagepub.com/doi/10.1177/0194599820936615?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -