Masaki Shigenori, Yamada Chizuko, Kawamoto Takashi
Department of Surgery and Gastroenterology, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan.
Department of Safety Management, Miyanomori Memorial Hospital, Sapporo 064-0953, Hokkaido, Japan.
World J Gastrointest Endosc. 2020 Oct 16;12(10):404-407. doi: 10.4253/wjge.v12.i10.404.
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation. Endotracheal intubation is usually performed using a laryngoscope; however, the operator needs to be in close proximity to the patient's face during the procedure, which increases the risk of droplet exposure. Therefore, we simulated fiberoptic endotracheal intubation on a mannequin representing the patient, using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope, in order to maintain distance from the patient during the procedure. We performed this procedure 10 times and measured the time required; the median procedure time was 6.4 s (interquartile range, 5.7-8.1 s). The advantage of this method is the short procedure time and distance maintained from the patients. The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients. In addition, this method can handle difficult airways without risk of misplacement of the endotracheal tube. However, it is necessary to consider the risk of aerosol generation associated with this procedure. In the pandemic setting of coronavirus disease 2019, this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.
严重急性呼吸综合征冠状病毒2引起的肺炎偶尔会变得严重，需要进行气管插管。气管插管通常使用喉镜进行；然而，在操作过程中操作人员需要靠近患者面部，这增加了飞沫暴露的风险。因此，我们在模拟患者的人体模型上模拟了纤维支气管镜引导下气管插管，使用超薄柔性胃肠内窥镜替代支气管镜，以便在操作过程中与患者保持距离。我们进行了10次该操作并测量所需时间；中位操作时间为6.4秒（四分位间距，5.7 - 8.1秒）。该方法的优点是操作时间短且与患者保持距离。胃肠内窥镜的柔性尖端可控性和长度有助于缩短操作时间并与患者保持距离。此外，该方法可以处理困难气道，且气管导管不会有放置错误的风险。然而，有必要考虑该操作相关的气溶胶产生风险。在2019冠状病毒病大流行背景下，当胃肠内镜医师负责对冠状病毒病2019患者进行气管插管时，这种方法可能有用。
