The Use of a Video-Assisted Intubating Stylet Technique in a Critically Ill and Contagious COVID-19 Patient

Abstract

Tracheal intubation and ventilatory support are among the important treatments in patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) and severe hypoxia. The intubating team often uses video-assisted intubation equipment to ensure a safe and successful tracheal intubation. In this case report, we demonstrate for the first time, the use of the Shikani video-assisted intubating stylet and the Shikani intubating technique as a safe, speedy, and effective way to intubate a critically ill and highly contagious COVID-19 patient. In addition to the conventional consensus guidelines that are currently available for good practice (such as the proper use of personal protection equipment, etc.), we demonstrated that using the Shikani video-assisted intubating stylet is a reliable and proficient technique that is easy to learn while minimizing the risk of COVID-19 exposure of the airway personnel.

The Use of the Shikani Video-Assisted Intubating Stylet Technique in Patients with Restricted Neck Mobility

“…Similarly, this is also true when VS is applied in patients with a rigid cervical collar, since we observed little if any, risky movement of the cervical spine ( Figure 2 , Figure 3 , Figure 4 and Figure 5 ). This finding is consistent with experiences described in our earlier clinical reports when we did not have any concerns of restricted neck motility [ 27 , 28 , 29 , 30 ]. Although external laryngeal manipulation might be helpful for VL in patients with C-spine immobilization [ 62 ], such maneuver is not necessary when using VS. Usually, sizable mouth opening and optimal jaw thrust are enough for maneuvering the intubating stylet into the oropharyngeal and laryngeal inlets and then obtaining sound glottis visualization.…”

“…Our institutions have extensive experience with the Shikani optical stylet, which has been widely studied in the management of a variety of difficult airways [ 27 , 28 , 29 , 30 ] and which has also proved effective in clinical conditions related to C-spine motility [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ]. In this report, we present our experience with the Shikani video-assisted intubating stylet technique ( Figure 1 ) as the routine airway management modality for patients with restricted head/neck mobility.…”

Video-Twin Technique for Airway Management, Combining Video-Intubating Stylet with Videolaryngoscope: A Case Series Report and Review of the Literature

“…The authors have had clinical experience with the Shikani VS technique for routine tracheal intubation since 2016 [ 9 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. In our 1100-bed medical center (7000 tracheal intubations annually), VS technique has been routinely applied in more than 90% of the patients who received tracheal intubation.…”

Video-Assisted Stylet Intubation with a Plastic Sheet Barrier, a Safe and Simple Technique for Tracheal Intubation of COVID-19 Patients

“…The clear and soft plastic sheet adds an additional layer of protection against the possible splash of secretion/mucus, without interference or hindering of the intubation procedure [ 13 ]. In this report, we share our own clinical experience of applying the Shikani video-assisted intubating stylet technique [ 14 , 15 , 16 , 17 ] with a plastic sheet that acts as an ancillary barrier in patients during the Omicron pandemic in Taiwan ( Figure 1 , time point B).…”