screen."
Changes in intubating practices
during the COVID-19 outbreak
could hasten the adoption of
these tools, which many providers
believe should be the gold stan-
dard of airway management. "I
still teach direct laryngoscopy to
new nurse anesthetists, but video
laryngoscopes are fabulous tools,"
says Dr. McMurray. "There's no
doubt video laryngoscopy is
developing into the standard of
care."
Buying time
Dr. Aziz says humidified high-flow
nasal oxygenation, which is often
used in intensive care units as a
bridge to intubation, is emerging as a useful tool for managing the dif-
ficult airway. The method provides oxygenation support that's more
comfortable for the patient than continuous positive airway pressure
(CPAP), bilevel positive airway pressure (BiPAP) or non-humidified
nasal oxygen.
"Providers can deliver 70 liters of oxygen quite comfortably,"
explains Dr. Aziz. "They avoid intubation and effectively maintain oxy-
genation for shorter duration procedures, which can be done without
placing an endotracheal tube.
"Monitoring CO2 and ventilation is the standard of care during seda-
tion," says Dr. Aziz. "Being unable to monitor these levels during the
2 4 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 2 0
SAFE AND SECURE Many intubations are routine, but
providers must always have a back-up plan in place to deal
with unanticipated challenges.
