**7.1 Introduction**

Endotracheal intubation is considered a very high-risk procedure in COVID 19 patients. For many reasons usually COVID 19 patients who need intubation urgently are critically ill patients with severe hypoxemia and respiratory failure. Desaturation is very quick because of depleted oxygen reserve and high consumption with regards to severe inflammatory status also involvement of other organ failure makes airway management of these cases are challenging. Special attention to the previous mentioned points may provide avoidance of major complications and avoidable deaths ensuring the safety of healthcare workers involved. Sever hypoxemia during ICU intubation has been reported in 25% [31]. In general, physiologically and anatomically airway management in critically ill patients consider challenging.

Optimizing communication: wearing full PPE make communication is really difficult so it is very important to use clear language with loud voice repeating the order to make sure communication is efficient. As recognizing a person with full PPE is somewhat difficult so, it is recommended to put sticker with individual name

*Airway Management in COVID-19 as Aerosol Generating Procedure*

*DOI: http://dx.doi.org/10.5772/intechopen.96889*

Using of heat moisture exchanger (HME filter) has been advised by many centers which can filter the viruses including Corona virus by 99 percent. HME filter should be attached most proximal to patient i.e. directly to ETT or between the mask and bag of Ambu, another alternative to HME filter that can be used is high efficiency particulate air filter (HEPA filter). Another HME filter is kept between

In covid 19 pandamic Video laryngoscopy is recommended as first line option

Higher chance for ETT pass first attempt, reducing chance of infection for the intubator by increasing the distance between the patient airway and the incubators face also use of special drapes is possible and might increase the level of protection, better intubation view can be achieved especially in full PPE situation where the

Two pieces of video laryngoscope (display, single use probe) are better to be used to make sure the intubator's face is far away from the patient's mouth during the procedure [36] in addition, first pass success rate is much higher in experienced

Preoxygenation is crucial part before intubating covid 19 patients as these patients are ill and prone to very rapid desaturation due to the nature of the disease. When it is possible 3–5 minutes of preoxygenation is recommended using non rebreathing mask with 10–15 liter/O2 which provide 100% Fio2, if NRM is not enough modified non invasive ventilation might needed with close circuit and HEPA filter. If bagging the patient is inventible for preoxygenation this should be done with two hand technique with HEPA filter however avoiding bagging the

Ideally pre-oxygenation could avoid necessity of bag mask ventilation but there

expiratory limb of anesthesia circuit and anesthesia machine (**Figure 2**).

on top of visor [35].

*7.2.3 Video laryngoscope*

*7.2.4 Pre-oxygenation*

**Figure 2.**

**9**

for airway management the rational be [44]:

face shield and googles (with fog) are obstructing clear view.

manager with video laryngoscope than direct laryngoscope.

patient is always recommended when it is possible [38].

is no guarantee especially in critical COVID 19 patients.

*Ventilation circuits setup (image courtesy Dr. Nabil Shallik).*

*7.2.2 Virus filters*
