AIROD® Cases

Case 1

70 yo female >50 pyh current smoker with severe COPD not on home oxygen presented with an oxygen saturation of 70%. She was found to have multi-lobar pneumonia predominately in the right upper and middle lobes. Despite Bipap therapy her hypoxia worsened, and she required intubation. Inspection of her oropharynx prior to intubation revealed very prominent 1st incisors as well as canines that were eroded at the roots left worse than right. Multiple black, necrotic molars right worse than left with a putrid odor. Her oxygen saturation, despite being on 15L nasal cannula, hovered in the low 90s. In anticipation of a difficult airway the AIROD® was prepared by extended the rods and ensuring the rods were in the locked position. A Miller 4 blade was gently inserted past the teeth and into the oropharynx. A grade 2 view was obtained. This was immediately followed by gentle insertion of the AIROD® which was advanced just distal to the vocal cords. An 8.0 endotracheal tube was advanced down the AIROD® by the respiratory therapist while the AIROD® was held in position. As the endotracheal tube was advanced into the oropharynx, hand position was changed from holding the AIROD® to holding the tip of the endotracheal tube while the respiratory therapist held the distal end of the AIROD®. The endotracheal tube was then advanced past the vocal cords and into the trachea while the respiratory therapist removed the AIROD® with ease. No complications occurred. No trauma occurred to the oropharynx, vocal cords or trachea. The patient was successful ventilated and oxygen saturations improved to high 90s. 

Case 2

61 yo male with severe schizophrenia and acute delirium with a PaO2 of 61 mmHg despite Bipap 14/6 on 90% fio2 with a minute ventilation of 18 L/min from multi-lobar pneumonia. A Miller 4 blade was gently inserted past the teeth and into the oropharynx. A grade 1 view was obtained. The AIROD® was gently advanced 2 cm past the vocal cords followed by an assistant advancing a 7.5 endotracheal tube down the AIROD® until grasped, then the endotracheal tube was slid into the trachea while the assistant held the distal end of the AIROD®. The AIROD® was then removed intact with no evidence of airway trauma.

Case 3

54 yo male with severe coronary artery disease on aspirin and Plavix with a history of a seizure disorder associated with alcohol withdrawal became unresponsive and a code blue was called. He was found to be apneic with oxygen saturation in the 50s. He was stimulated by the Hospitalist and woke up. He was transferred to the ICU where he became completely unresponsive again and stopped breathing. He was immediately ventilated with a bag-valve mask and oxygenation improved to 100%. He then bolted up out of bed and became very combative. Propofol was given and he was laid supine and ventilated with a bag-valve mask. Inspection of his oropharynx revealed a very large tongue, some missing and multiple sharp teeth with mouth opening of only 2 fingerbreadths. There was blood and emesis in his oropharynx that was suctioned. A Miller 4 blade was inserted into the oropharynx but only a grade 4 view could be obtained. The AIROD® was inserted into the oropharynx in the fully extended and locked position and the proximal tip was used to gently lift the epiglottis exposing the vocal cords and improving the view to a grade 2. AIROD® was advanced 2 cm past the vocal cords and an assistant advanced an 8.0 endotracheal tube down the AIROD® until it was grasped, and the endotracheal tube was advanced successfully past the vocal cords while the assistant held the distal end of the AIROD®. The AIROD® was removed intact without any oropharyngeal or vocal cord trauma.

Case 4

A 48 yo male obese alcoholic smoker who was critically ill with an admission albumin of 0.9 and lactic acid of 9 with multiorgan system failure from an intra-abdominal abscess with septic shock on 15 mcg/min of epinephrine and 25 mcg/min of Levophed was obtunded and in acute respiratory failure. The AIROD® was pre-loaded with an 8.0 endotracheal tube onto the distal end of the AIROD® prior to providing sedation with Etomidate and bag-valve mask ventilation in anticipation of a difficult airway: full beard, mouth opening 2 cm, large tongue, collapse of the walls of the oropharynx as well as false cords. Using a Miller 4 blade a grade 2 view was obtained and the AIROD® was advanced 1 cm past the vocal cords followed by the endotracheal tube while an assistant held the distal end. There was no significant desaturation or trauma to the vocal cords or oropharynx. Pre-loading the AIROD® with the endotracheal tube improved the speed and autonomy of the intubation.

Case 5

A 71 yo female 5’3 70 kg with CKD 3 from NSAIDs and h/o MI admitted with septic shock from acute colitis on 10 levophed despite 6L fluids with renal failure, hyperkalemia, profound metabolic acidosis with a lactate >15 and a VBG pH 6.87 required emergent intubation. She was combative from acute encephalopathy, Mallampati IV, mouth opening was 3 cm after removal of dentures and she had a large tongue. The AIROD® was pre-loaded with a 7.0 endotracheal tube on the distal end. The proximal end of the AIROD® was kept clean by placing into the endotracheal tube packaging with the 20-degree tip pointing to the right and lying flat on the mattress. The AIROD® was then tucked underneath the patient’s right shoulder at a 45-degree angle to the neck for quick access by the operator. The patient received a small dose of propofol and was immediately ventilated with a bag-valve mask. A MAC 3 blade was gently placed into the mouth and a grade 2 view was obtained. The pre-loaded AIROD® was grasped at the smallest proximal section with the operator’s hand in the supine position while the operator’s eyes were fixed on the vocal cords. The square AIROD® was then rotated one 90 degrees turn  counterclockwise only by feel without looking at the AIROD®. The AIROD® was gently inserted into the mouth and advanced just pass the vocal cords 2 cm. The respiratory therapist held the distal end while the 7.0 endotracheal tube was advanced down the AIROD®. It only took 10 seconds to intubate from insertion of the MAC blade until removal of the AIROD® and inflation of the endotracheal tube.

Case 6

83 yo male 5’6 85 kg non-smoker with prior DVT/PE on Eliquis, hemolytic anemia, CLL on rituximab and previous histoplasmosis s/p partial lung resection developed acute respiratory failure despite broad spectrum antibiotics and steroids. CT chest revealed diffuse ground glass opacities throughout his LUL, RML and RLL. He was started on bipap 12/6 w/ fio2 60% but hypoxia worsened despite a minute ventilation of 26 L/min. He was transferred to the ICU and immediately intubated. The AIROD® was pre-loaded with an 8.0 endotracheal tube at the distal end and tucked under the patient’s right shoulder with the tip lying flat and pointing laterally protected in its packaging. The AIROD® lay at a 45-degree angle to the neck. He was given propofol and immediately ventilated with a bag-valve mask. A Miller 4 blade was gently inserted into the mouth with a grade 1 view followed by grasping the AIROD® with the operator’s hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was advanced into the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. The intubation took approximately 10 seconds. A diagnostic bronchoscopy was performed next and did not reveal any tracheobronchial trauma.

Case 7

52 yo male 5’8 with alcoholic liver cirrhosis on lactulose with Guillain-Barre syndrome treated with mycophenolate mofetil fell a few weeks prior to this admission and suffered an unstable pelvic fracture along with a fractured right 9th rib had been convalescing in a nursing home when he developed flu like symptoms treated with Tamiflu. He was transferred to the hospital for worsening shortness of breath. Initial CXR showed ground glass opacities RUL, RLL and LLL with an abg of 7.38/28/51 on 4L fio2. Lactate 1.3. Procalcitonin elevated at 0.27. Hypoxia progressed over the ensuing evening requiring non-rebreather 15L/min with O2 saturation 95%. Repeat CXR revealed worsening ground glass opacities involving all lobes of the lung.

Airway assessment revealed Mallampati 4, stiff neck, missing left canine and only a 1 cm mouth opening. The AIROD® was pre-loaded with an 8.0 endotracheal tube at the distal end and tucked under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. The patient was laid flat and towels were placed under his head for optimal positioning. He was given propofol and succinylcholine. Bag-valve mask ventilation was not performed in order to minimize the chance of aerosolizing suspected COVID-19 virus. A narrow Miller 4 blade (only 1 cm wide – only Miller blade available) was gently inserted into the mouth with a grade 3b view. The AIROD® was grasped with the right hand while still looking at the epiglottis and the tip facing up was used to gently lift the epiglottis. The vocal cords were not visualized. The AIROD® was advanced a few centimeters past the epiglottis and an 8.0 ETT was advanced with resistance. The AIROD® was removed intact and the ambu-bag was connected to the ETT and bagging commenced for approximately 10 seconds, however, oxygen saturations fell below 90% so the ETT was immediately removed and ambu-bag was initiated for approximately 1 minute bringing the oxygen saturations up to 99%. Using cricoid pressure and a Mac 3 blade a 3b view was obtained and again the AIROD® was gently advanced and used to lift the epiglottis improving the view to a grade 2 view. The AIROD® was advanced 2 cm past the glottis then a pre-loaded 7.5 ETT was advanced down the bougie and into the trachea. The AIROD® was removed intact and the patient was ventilated effectively with good CO2 exchange. MAP >65 at the end of the procedure with oxygen saturation 99%. Airway plateau pressure was 26. CXR confirmed good ETT placement above the carina with no evidence of pneumothorax or significant oropharyngeal trauma.

Case 8

60 yo female 5’3 68 kg with a history of prior hepatic and renal transplant 2 years ago on cyclosporine and prednisone for rejection requiring dialysis for renal failure developed worsening fever and productive cough over the last 6 days and was admitted early this afternoon. She was placed in airborne isolation for suspected COVID-19 infection. Shortly after returning from dialysis this evening she developed acute bradycardia and a code blue was called as she was found pulseless and foaming at her mouth. I responded to the code blue. Upon arrival there were 3 nurses in the room performing CPR wearing CAPR protective personal equipment helmets. I put on my N95 mask and face shield and immediately proceeded to the head of the bed to where bag-valve mask ventilation was being performed to intubate. The bed was only off the floor 2 feet, so I had to get down on my knees. I pre-loaded the AIROD® with a 7.0 endotracheal tube at the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. Without interrupting chest compressions, I inserted a Miller 4 blade, all I could see was white/tan pus. There was no suction available. I use the AIROD® to help clear the pus from the vocal cords and a grade 1 view was obtained. The AIROD® was advanced 2 cm past the glottis then a pre-loaded 7.0 ETT was slid down the AIROD® and into the trachea. The AIROD® was removed intact and the patient was ventilated effectively with good CO2 exchange. The intubation took 12 seconds. Return of spontaneous circulation happened quickly. Later in the ICU bronchoscopy confirmed tracheal placement of the endotracheal tube without any oropharyngeal or tracheobronchial tree trauma.

Case 9

67 yo female 5’7 91 kg with atrial fibrillation, diabetes, hypertension, gastric bypass with appendectomy and cholecystectomy developed acute nausea and abdominal pain 2 days prior to admission. She underwent a laparotomy yesterday to fix a small bowel obstruction. She was convalescing on surgical ward when she developed acute hypoxic respiratory failure. She was immediately transferred to the ICU. She had a complete collapse of her right lung with the entire right hemi-thorax opaque with tracheal deviation towards the right. Despite a non-rebreather mask her oxygen saturation was 78% and she was in shock with a BP of 50/30. She was positioned with a towel between her shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube at the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given epinephrine along with propofol for sedation and immediately ventilated with a bag-valve mask. A Miller 4 blade was gently inserted into the mouth with a grade 1 view followed by grasping the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any evidence of oropharyngeal trauma. The intubation took 11 seconds. A therapeutic bronchoscopy was performed to decompress the right mainstem bronchus which was completely occluded by thick mucus. No oropharyngeal or tracheobronchial trauma occurred.

Case 10

83 yo female 5’6 144 kg with gram negative bacteremia from a UTI, septic shock with an LV EF 15-20%, AF w/ RVR, pulmonary artery 37 mm on CT chest, shock liver, ATN Cr 4.3 and lactate of 8.2 required intubation. Mallampati 4, large tongue, large neck, limited neck movement, dry oropharynx with thick mucus, missing upper teeth and a few lower teeth with necrotic base of lower incisors. She was positioned with a towel between her shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given etomidate along with some propofol for sedation and immediately ventilated with a bag-valve mask. A Miller 4 blade was gently inserted into the mouth. Thick mucus enveloped the light of the laryngoscope limiting the view of the oropharynx. The AIROD® was inserted into the oropharynx and used to scrape away the mucus covering the light and a grade 1 view was obtained. The AIROD® was gently advanced 2 cm passed the vocal cords and the endotracheal tube was advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any damage to the oropharynx. The intubation took 18 seconds.

Case 11

73 yo male 5’10 87 kg with hemorrhagic CVA unable to control his secretions required intubation. Mallampati 3, lower dentures and upper veneers. He was positioned with a towel between his shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 150 mg propofol for sedation and immediately ventilated with a bag-valve mask. A Miller 4 blade was gently inserted into the mouth revealing a grade 1 view followed by grasping the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 2 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any evidence of oropharyngeal trauma. A stopwatch was started upon initial airway inspection with insertion of the laryngoscope and stopped with inflation of the endotracheal tube cuff. The intubation procedure lasted 9 seconds.

Case 12

79 yo male 5’6 43kg with DM II and hypothyroidism on Baclofen and Librium for anxiety fell at home and was admitted for a mild case of rhabdomyolysis two days prior. He was found hypoxic and obtunded in the early afternoon and a code blue was called. He was intubated on the floor for oxygen saturation in the 40s by anesthesia. Despite full ventilatory support with Vt 500 PEEP 10 RR 25 and FiO2 100% his oxygenation remained in the 70s. He was transferred to the ICU where I immediately performed an ECHO while awaiting CXR: no evidence of RV strain or septal flattening to suggest a pulmonary embolism. CXR revealed a collapsed left lower lobe and lingula and tracheal deviation to the left. Immediately I inserted a bronchoscope into the 7.5 endotracheal tube. After a few minutes I was able to make a small hole through the thick material blocking the left mainstem as well as the left upper and lower bronchi. Oxygenation improved to 100%. I was unable to clear the large pieces of material through the 7.5 endotracheal tube, so it was removed. This was followed by placement of a Miller 4 blade gently into the patient’s mouth revealing a grade 1 view. I then grasped the AIROD® which lay pre-loaded with an 8.5 endotracheal tube protected with an OR towel with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any evidence of oropharyngeal or tracheal trauma. Significant time was then spent utilizing biopsy forceps, rat tooth forceps and an electrocautery probe to remove all pieces of chicken and vegetables that he had accidentally aspirated into his lungs. He was extubated the next day with no evidence of hypoxic brain injury.

Case 13 

63 yo female 5’5 110 kg with COPD, morbid obesity, OSA, AF, DM, and anxiety suffered a  cardiac arrest and was successfully resuscitated with placement of a drug eluting stent into the RCA. One week later she required intubation for acute respiratory failure. Extubated the following day and developed stridor which resolved with pain medication and racemic epinephrine. Two days she developed acute respiratory failure again with stridor that resolved after receiving 4 mg IV versed. A diagnosis of paroxysmal vocal cord dysfunction was made. The following day she developed similar symptoms that responded to additional versed and Precedex. The next morning, she became anxious after Precedex was stopped and once again developed acute stridor with respiratory failure responding to Zyprexa and versed momentarily. She was comfortable throughout the day until her stridor resumed and despite Bipap she was unable to adequately ventilate. She became obtunded prompting intubation. In addition to stridor her Mallampati was 4, she had sharp prominent full set of teeth, airway opening 1.5 cm, large tongue with excessive oropharyngeal tissue, false cords and vocal cord swelling. I pre-loaded the AIROD® with a 7.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given 20 mg of etomidate and immediately ventilated with a bag-valve mask. A Miller 4 blade was gently inserted into the mouth revealing a grade 4 view with purulent mucus in her oropharynx. I grasped the AIROD® with my hand supine and used it to manipulate the false cords and reveal the true vocal cords while cricoid pressure was being applied. A grade 2 view was obtained. The cords were adducted with a posterior glottal chink. The AIROD® was gently passed 2 cm through the tiny opening at the bottom of the vocal cords dilating the area with the smooth proximal tip. The endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any evidence of oropharyngeal trauma. Successful first-attempt intubation without complications. Bronchoscopy confirmed no tracheobronchial tree trauma.

Case 14

19 yo male 5’9 118 kg with autism spectrum disorder and influenza A pneumonia intubated on arrival to the hospital for acute respiratory failure and possible overdose was extubated on day 4 and developed a complete occlusion of his right mainstem bronchus. He was positioned with a towel between his shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg propofol and rocuronium 50 mg. A Miller 4 blade was gently inserted into the mouth revealing a grade 2 view followed by grasping of the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 2 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The glottic opening was narrowed by vocal cords swelling so the endotracheal tube was twisted in order to pass it into the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. A stopwatch was started upon initial airway inspection with insertion of the laryngoscope and stopped with inflation of the endotracheal tube cuff. The intubation procedure lasted 13 seconds. 

Case 15

72 yo male 5’11 131 kg prior tobacco use with COPD on home oxygen, CKDz, diastolic dysfunction and paranoid schizophrenia developed acute shortness of breath over 24 hours. He arrived via ambulance to the ED on high flow oxygen. He had a fever of 102, a non-productive cough, lethargy and confusion. Procalcitonin 0.08 and wbc 9.5. CXR lobar consolidations involving the entire right lung with small LLL infiltrate. He arrived to the ICU and was placed in isolation for PUI for COVID-19. He was edentulous with a Mallampati score of 4. He was positioned with a towel between his shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg propofol followed immediately by rocuronium 50 mg. A Miller 4 blade was gently inserted into the mouth revealing a grade 1 view followed by grasping of the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any evidence of oropharyngeal trauma. A timer was started upon initial airway inspection with insertion of the laryngoscope and stopped with inflation of the endotracheal tube cuff. The intubation procedure lasted 10 seconds.

Case 16

51 yo 5’10 193 kg with cirrhosis, septic shock, coagulopathy, anemia with hemoglobin of 6.7 and thrombocytopenia with platelets of 16 actively bleeding from his trialysis catheter developed worsening metabolic encephalopathy and respiratory failure not responding to bipap 100% Fio2 O2 sats 94%. Morbidly obese, Mallampati 4, large tongue, large lips, missing and cracked sharp teeth, blood in oropharynx, mouth opening 2 cm. He was positioned with a towel between his shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 100 mg propofol. A Miller 4 blade was gently inserted into the mouth which was very dry. The tongue was lifted, and fresh blood visualized around the glottis. Cricoid pressure was applied revealing a grade 1 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. Cricoid pressure was released, The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. There was excessive oropharyngeal tissue surrounding the vocal cords requiring  endotracheal tube twisting in order to pass the ETT into the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. Rocuronium 50 mg was then given.

He was ventilated adequately for 15 minutes; however, I could hear a tiny air leak so the ETT was removed after giving 100 mg of propofol. The AIROD® lay at a 45-degree angle to the neck tucked under the right shoulder with pre-loaded the AIROD® with a 7.5 ETT. A Miller 4 blade was gently inserted into the mouth revealing a small amount of fresh blood that was suctioned. A grade 1 view was obtained followed by grasping of the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 2 cm past the vocal cords and the endotracheal tube was then advanced into the trachea while the respiratory therapist held the distal end of the AIROD®. The AIROD® was removed intact without any evidence of oropharyngeal trauma.

Case 17

43 yo male 5’10 87 kg male alcoholic with an acute subdural hematoma and delirium tremens was having hallucinations and developed intermittent apneic episodes with oxygen saturations in the 70s. He was positioned with a towel between his shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg propofol and rocuronium 50 mg. I inserted a Miller 4 blade gently into his mouth and had a grade 2 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no one holding the AIROD®. The AIROD® was not significantly advanced any further into the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. A timer was started upon initial airway inspection with insertion of the laryngoscope and stopped with inflation of the endotracheal tube cuff. The single-handed first-attempt intubation lasted 17 seconds.

Case 18

72 yo male 5’9 88 kg non-smoker with no know medical problems admitted to the COVID-19 ward became more lethargic but not tachypneic or tachycardic despite being found in shock with an ABG of 7.45/33/63 on a 100% NRB transferred to the ICU and placed in isolation for SARS-CoV-2 severe ARDS. He was positioned with a towel between his shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 100 mg propofol and rocuronium 50 mg. I inserted a Miller 4 blade gently into his mouth revealing a grade 1 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® did not advance significantly down the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. The single-handed first-attempt intubation was performed quickly.

Case 19

60 yo female 5’4 65 kg non-smoker DM II, HTN, OSA and adrenal insufficiency on hydrocortisone 30 mg tid was complaining of fever, chills and cough. She tested positive for COVID -19 and was hospitalized 5 days later for worsening shortness of breath. CXR on admission revealed small bilateral lower lobe infiltrates with oxygen saturation of 85%. Over the ensuing 13 days she developed SARS-CoV-2 with diffuse ground glass opacities and despite Bipap at 100% fiO2 her O2 sats would not go above 84%. She was positioned with a towel between her shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given 150 mg propofol and rocuronium 50 mg. I inserted a Miller 4 blade gently into her mouth revealing a grade 1 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® did not advance significantly down the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. The single-handed first-attempt intubation was a performed very quickly.

Case 20

60 yo female 4’10 72 kg non-smoker with non-insulin dependent DM II admitted 7 days ago for cough and worsening shortness of breath 3 days prior to admission. COVID-19 positive on admission, progressed to SARS-Cov-2. Placed in the prone position today while on 15 L NRB and 15L NC. Unable to keep oxygen saturations above 86% her PaO2 was 62. CXR revealed a dramatic change from bilateral ground glass infiltrates to consolidations in all lobes. She was positioned with a towel between her shoulder blades to extend the neck into the sniffing position. I pre-loaded the AIROD® with a 7.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given 100 mg propofol and rocuronium 50 mg. I inserted a Miller 4 blade gently into her mouth revealing a grade 1 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently passed 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® did not advance significantly down the trachea. The AIROD® was removed intact without any evidence of oropharyngeal trauma. The single-handed first-attempt intubation was a performed fast.

Case 21

54 yo male 5’11 93kg with NIDDM, HTN and GERD admitted 5 days prior for worsening dyspnea, cough and fever. Diagnosed with COVID-19. Progressed to severe ARDS secondary to SARS CoV-2. Despite 15L NRB, 15L NC and prone position O2 sat 84%. ABG 7.49/26/43. He was slightly confused and able to barely speak. I pre-loaded the AIROD® with a 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg propofol and rocuronium 50 mg without bag-valve-mask ventilation to diminish exposure. I inserted a Miller 4 blade gently into his mouth revealing a grade 2 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently inserted 2 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of oropharyngeal trauma. The single-handed first-attempt intubation was a performed successfully in 10 seconds.

Case 21

54 yo male 5’11 93 kg with NIDDM, HTN and GERD admitted 5 days prior for worsening dyspnea, cough and fever. Diagnosed with COVID-19. Progressed to severe ARDS secondary to SARS CoV-2. Despite 15L NRB, 15L NC and prone position O2 sat 84%. ABG 7.49/26/43. He was slightly confused and able to barely speak. I pre-loaded the AIROD® with a 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg propofol and rocuronium 50 mg without bag-valve-mask ventilation to diminish exposure. I inserted a Miller 4 blade gently into his mouth revealing a grade 2 view. I grasped the AIROD® with my hand supine while still looking at the vocal cords. The AIROD® was gently inserted 2 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of oropharyngeal trauma. The single-handed first-attempt intubation was a performed successfully in approximately 10 seconds.

Case 22

71 yo male 5’10 101 kg w/ NIDDM, HTN and obesity intubated 18 days prior for Severe ARDS secondary to SARS-CoV-2 lost his airway and the attending physician was unable to intubate using the Glidescope so an emergency tracheostomy was performed with placement of a 5.0 Shiley. The night of the 24th day of ventilation he was unable to be ventilated effectively with his PCO2 rising to 73 with a Ph of 7.13. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was on a propofol drip and 10 mg Vecuronium was given while being ventilated through the 5.0 tracheostomy. He was actively bleeding from his nasopharynx. I inserted a Miller 4 blade gently into his mouth revealing a bloody and swollen oropharyn. I grasped the AIROD® with my hand supine while still looking at the bloody oropharynx and used the AIROD® to gently displace tissue revealing a grade 1 view. The AIROD® was gently inserted 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea abutting the tracheostomy tube. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was a performed in 19 seconds. I then proceeded to exchange the 5.0 tracheostomy for an 8.0 tracheostomy. Bronchoscopy confirmed no acute oropharyngeal or tracheal trauma with the tracheostomy in the correct position in the trachea.

Case 23

55 yo male 5’7 59 kg tobacco smoker and vaper with no medical history developed sob, cough and fever over two weeks diagnosed with COVID-19 pneumonia treated with 30L/min Fio2 100% on the wards for two days with an abg of 7.48/37/49. He looked comfortable and was able to speak in short sentences and was coherent. He was not tachycardic and pulse oximeter read 100% when ABG was drawn revealing a PaO2 of only 49. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg propofol and rocuronium 50 mg without bag-valve-mask ventilation to diminish exposure. I removed his partial upper and lower middle dentures. I inserted a Miller 4 blade gently into his mouth revealing a grade 1 view. The AIROD® was gently inserted 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of oropharyngeal trauma. The single-handed first-attempt intubation was a performed rapidly.

Case 24

60 yo female 5’6 72 kg non-smoker with no known medical problems diagnosed with COVID-19 seven days prior to admission with fever, lethargy and progressive shortness of breath requiring 21 L/min 100% fio2 suddenly dropped her oxygen saturation to 82% requiring intubation for severe ARDS due to SARS CoV-2. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given 150 propofol and 50 rocuronium. I inserted a Miller 4 blade gently into her mouth revealing a very large dry tongue and oropharynx. I grasped the AIROD® with my hand supine while looking at the vocal cords grade 2 view. The AIROD® was gently inserted 2 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was a performed in 36 seconds.

Case 25

85 yo male 6’0 89 kg with COPD, A fib, HTN, CKD and OSA developed Severe ARDS secondary to SARS-CoV-2. Initial abg 7.51/28/130 on 10 L/min. ABG two days after admission on 30 L/min 7.32/44/49. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. He received propofol and rocuronium. I inserted a Miller 4 blade gently into his mouth revealing a bloody oropharynx. I grasped the AIROD® with my hand supine while looking at the vocal cords grade 1 view. The AIROD® was gently inserted 2 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea abutting the tracheostomy tube. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed in 11 seconds. 

Case 26

64 yo female 5’6 70 kg with HTN, hyperlipidemia, hypothyroidism and CVA residing at nursing home developed fever, chills and malaise 5 days ago. She became short of breath with a non-productive cough and was admitted 2 days ago. This morning she developed mild hemoptysis while off subcutaneous heparin and acute respiratory failure approximately one hour after receiving remdesivir with oxygen saturations in the 60s despite 30 L/min 100% oxygen. She was transferred to the ICU and was found to be in severe respiratory distress. Plan for intubation for Severe ARDS due to SARS CoV-2. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given 150 propofol and 150 succinylcholine. I inserted a Miller 4 blade gently into her mouth revealing a bloody oropharynx. I grasped the AIROD® with my hand supine while looking at the vocal cords grade 1 view. The AIROD® was gently inserted 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed in 12 seconds.

Case 27

66 yo female 5’0 89 kg smoke with COPD, NIDDM, PVD, HTN and schizophrenia admitted with SOB and managed on the COVID wards requiring 6L. Two days later she needed 10L then became abruptly short of breath and despite 30L fio2 100% O2 sats 60s. She received remdesivir a few hours prior to her acute respiratory event. She immediately was transferred to the ICU. Right chest was not moving and breath sound absent consistent with a right  pneumothorax and she had mild hemoptysis while receiving full dose lovenox. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally protected with a sterile OR towel. The AIROD® lay at a 45-degree angle to the neck. She was given 150 propofol and 150 succinylcholine. I inserted a Miller 4 blade gently into her mouth revealing multiple missing teeth and a large tongue with mouth opening of only 2 fingerbreadths. I grasped the AIROD® with my hand supine while looking at the vocal cords grade 1 view. The AIROD® was gently inserted 1 cm past the vocal cords and the endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed in 10 seconds. 

Case 28 

55 yo male 5’5 85 kg non-smoker with DM not on insulin, HTN, hyperlipidemia and left foot infected ulcer presented with 5 days of myalgia, cough, decreased appetite and shortness of breath. ABG on admission on 15L NRB 7.35/29/49. The following day his oxygen saturation was 84% on 30 L/min 100 Fio2. He was transferred to the ICU and placed on Bipap because he adamantly refused intubation despite multiple conversations with the interpreter and family. After 3 days on bipap he said he wanted to be intubated but wanted to speak with his family first. He then abruptly loss consciousness and became pulseless. CPR was immediately begun, and I rushed into to intubate. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. His teeth were clamped shut because he was seizing. He was given 50 propofol and 150 succinylcholine.

I inserted a Miller 4 blade gently into his mouth revealing a few missing teeth, sharp teeth, large tongue, mouth opening of barely 2 fingerbreadths, bloody mucus and hamburger appearing oropharynx. I manipulated the cricoid cartilage to reveal a grade 1 view. I then grasped the AIROD® with my hand supine while looking at the vocal cords. As the AIROD® was gently advanced into the oropharynx the light source on the laryngoscope went dark. I continued to gently advance the bougie forward while knowing that the tip was facing up because of the feel of the square handle. I could feel the tracheal rings. The endotracheal tube was then advanced slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed very quickly. Bronchoscopy was immediately performed revealing no evidence of tracheal trauma.

Case 29

52 yo 5’0 59 kg non-smoking female with NIDDM, HTN and hyperlipidemia developed body aches, fever and malaise 10 days prior to hospitalization. She then developed a non-productive cough and shortness of breath. O2 saturations 70% on RA in the ED. ABG while on 14 L/min was 7.52/39/63. She was treated on the floor with remdesivir, proning, full dose lovenox and increasing oxygen flows up to 30 L/min. I recommended to the hospitalist service to check ABGs on patients every day because of that fact that oximeters read falsely high on these patients. She developed severe ARDS due to SARS CoV-2 on hospital day 3 ABG while on 30 L/min was 7.49/33/51. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. She was given 100 propofol and 150 succinylcholine. I inserted a Miller 4 blade gently into her mouth revealing mouth opening of only 1.5 cm, large tongue and anterior glottis. Cricoid cartilage pressure was applied. I then grasped the AIROD® with my hand supine while looking at the epiglottis. The AIROD® was gently advanced into the oropharynx and used to lift the epiglottis revealing a grade 2 view. The AIROD® was advanced past the vocal cords 2 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed very fast.

Case 30

55 yo female 5’1 103 kg obese smoker with NIDDM, CKD stage 3, PVD, HTN and RA on hydroxychloroquine and prednisone 10 mg daily complaining of weakness, productive cough, shortness of breath and dizziness. Oxygen requirement increased over the next 3 days with an ABG while on 7L of 7.32/31/74. NSTEMI with a troponin of 33 and creatinine of 4.2 increased from 1.8. I proctored another physician while he intubated. He pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. She was given 100 propofol and 150 succinylcholine. He inserted a Miller 4 blade gently into her mouth revealing mouth opening of 2 cm, large tongue and some missing teeth. He then grasped the AIROD® with his hand supine while looking at the oropharynx. He gently advanced the AIROD® into the oropharynx and past the vocal cords followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. He inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed without any complications.

Case 31

62 yo male 5’10 121 kg non-smoker, obese, asthma, COPD, IDDM and HTN with an O2 saturation of 55% and glucose of 548 was placed on 15L NRB with an ABG 7.35/55/68. He was managed on the wards with full dose Lovenox. He required an additional 15L NC six days later with an ABG of 7.48/51/132. On the seventh day I was consulted as his O2 saturations would not go above 88% and I immediately recommended intubation for SARS CoV-2 SEVERE ARDS. ABG 7.45/59/62 on 30 L/min. Two towels were rolled up and placed between his shoulder blades in order to achieve the optimal sniffing position. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. He was given 200 propofol and 150 succinylcholine. I inserted a Miller 4 blade gently into his mouth revealing mouth opening of only 1.5 cm, prominent full set of teeth, large very dry tongue, hamburger oropharynx with bloody mucus and a very anterior glottis with false cord and excessive oropharyngeal tissue. Cricoid cartilage pressure was applied. I could not see the vocal cords. I manipulated the trachea and had RT apply cricoid pressure. I then grasped the AIROD® with my hand supine while looking at the epiglottis. The AIROD® was gently advanced and used to probe the oropharynx and used to move the false cords to the side barely exposing the right vocal cord. The AIROD® was advanced past the vocal cords 3 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed quickly. Bronchoscopy confirmed no damage to the tracheobronchial tree.

Case 32

50 yo female 5’8 72 kg methamphetamine and alcohol abuse with hepatitis C cirrhosis, cardiomyopathy and IDDM admitted for cough and worsening shortness of breath for a week. ABG in ED 7.53/32/80 on 2L. She developed SARS CoV-2 SEVERE ARDS four days later on 15L NRB ABG 7.36/48/54 and was transferred to the ICU. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10 cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. She was given 150 propofol and 150 succinylcholine. Bag-valve-mask ventilation was not performed to minimize exposure. I inserted a Miller 4 blade gently into her mouth revealing a large dry tongue, missing and cracked teeth. I then grasped the AIROD® with my hand supine while looking at the grade 1 view. The AIROD® was gently advanced into the oropharynx past the vocal cords 2 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed in 19 seconds.

Case 33

49-year-old female 4’10 71 kg non-smoker with non-insulin dependent diabetes was transferred from another hospital yesterday for worsening shortness of breath. Her partial pressure of oxygen was 136 on 5 L/min prior to transfer. Early this am she developed respiratory distress and despite 30 L/min her oxygen saturations were only in the 70s. She was transferred to the ICU for SARS COV2 SEVERE ARDS. I pre-loaded the AIROD® with a 7.5 endotracheal tube that had attached to it a 10-cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. She was given 150 propofol and 150 succinylcholine. She clenched her teeth. I inserted a Miller 4 blade gently into her mouth revealing mouth opening of only 1.5 cm, large tongue and anterior glottis. Cricoid cartilage pressure was applied revealing a grade 2a view. I then grasped the AIROD® with my hand supine while looking at the glottis. The AIROD® was gently advanced into the oropharynx past the vocal cords 2 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed very quickly.

Case 34

57-year-old male roofer with no known medical history or COVID-19 exposure developed fever, cough, and generalized weakness two days prior to admission. He was initially treated with hyperbaric oxygen therapy for SARS COV2 pneumonia with an arterial blood gas of 7.51/31/60 on 8 L/min. His oxygenation worsened significantly three days later necessitating intubation for SEVERE ARDS. On the 24th day of positive pressure ventilation he could no longer ventilate. He was receiving propofol and fentanyl infusion. Rocuronium 50 mg IV was given. His endotracheal tube was removed because of suspected acute airways obstruction which was confirmed, immediately followed by intubation with a pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10-cc syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. I inserted a Miller 4 blade gently into his mouth revealing mouth opening of 2 cm, large tongue, some missing teeth, bloody oropharynx and an anterior glottis. Despite cricoid cartilage pressure I was only able to see a grade 3 view. I then grasped the AIROD® with my hand supine while looking at the oropharynx. The AIROD® was used to lift oropharyngeal tissue that was blocking the glottis out of the way revealing a grade 1 view. The AIROD® was then gently advanced past the vocal cords 2 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact. The single-handed first-attempt intubation was performed without any evidence of acute oropharyngeal trauma.

Case 35

64-year-old 6’1 male 124 kg non-smoker with a past medical history significant for rheumatic fever as a child, obesity, OSA without home CPAP and hypertension complaining of fevers up to 102 F and chills for two weeks. One week prior to admission he developed shortness of breath and myalgia. His wife convinced him to go to the hospital as he too weak to get out of bed. SpO2 on admission was 85% on room air. He was diagnosed with COVID-19 pneumonia and admitted to the ICU. On arrival to the ICU on 6 L/min his ABG was 7.42/38/62. His chest x-ray revealed multi-lobar small infiltrates and partial consolidation of the left upper lobe. Less than 24 hours later his ABG was 7.38/43/96 on 40 L/min high flow with an FiO2 of 92%. He was short of breath but coherent and able to speak in short sentences. He was not tachycardic or tachypneic. He was intubated for MODERATE ARDS due to SARS-CoV-2. I pre-loaded the AIROD® with an 8.0 endotracheal tube that had attached to it a 10 mL syringe onto the distal end and tucked it under the patient’s right shoulder with the tip lying flat and pointing laterally. The AIROD® lay at a 45-degree angle to the neck. He was given 200 mg Propofol IV and 200 mg Succinylcholine IV. I inserted a Miller 4 blade gently into his mouth revealing a large tongue and anterior glottis. Cricoid cartilage pressure was applied revealing a grade 2 view. I then grasped the AIROD® with my hand supine while looking at the glottis. The AIROD® was gently advanced into the oropharynx past the vocal cords 2 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed without any complications.

Case 36

70-year-old 5’9 male 78 kg former tobacco user with a past medical history significant for coronary artery disease, CABG x 4, pulmonary embolism, atrial fibrillation and biventricular AICD for ischemic cardiomyopathy underwent PCI with placement of a drug eluting stent five days ago and discharged with Plavix and Xarelto. He developed an acute bleed from a gastric ulcer that was clipped via EGD yesterday. I responded to a code blue this evening. Upon arrival chest compressions were being performed. I immediately dropped to my knees and inserted a 4 Miller blade into his oropharynx. The AIROD® was pre-loaded with an 8.0 endotracheal tube in my other hand and was used to clear the copious secretion away from the vocal cords. There was no suction available. A grade 2 view was obtained. The AIROD®was gently advanced into the oropharynx past the vocal cords 2 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. I inflated the endotracheal balloon then removed the AIROD® intact without any evidence of acute oropharyngeal trauma. The single-handed first-attempt intubation was performed without interrupting chest compressions. No evidence of oropharyngeal trauma or complications.

Case 37

35-year-old 5’11 male 111 kg smoker with a past medical history significant for alcoholism, esophageal erosion, severe depression with prior suicide had been drinking when he overdosed with hydroxyzine and oxcarbazepine. He was transferred from another hospital already intubated. On arrival he had vomitus on his beard and in his oropharynx. The endotracheal tube cuff was blown. He was on a Propofol and Fentanyl drip. Succinylcholine 200 mg was given. The blown endotracheal tube was removed. A Miller 4 blade was gently inserted into his mouth revealing a large tongue and copious secretions. Cricoid cartilage pressure was applied revealing a grade 2 view. The AIROD® was gently advanced into the oropharynx past the vocal cords 3 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. The AIROD® was pulled back as the endotracheal tube was advanced down the trachea. The endotracheal balloon was inflated followed by removal of the AIROD® intact without any evidence of acute oropharyngeal trauma. Single-handed first-attempt intubation with an 8.0 endotracheal tube performed in 28 seconds.

Case 38

64-year-old 5’8 male 72 kg smoker with a past medical history significant for peripheral arterial disease, insulin dependent diabetes, bilateral lower extremity amputations, COPD and chronic kidney disease stage 3 was diagnosed with acute mitral valve regurgitation and transferred for valvular replacement surgery. He arrived in acute respiratory failure on BiPAP with an FiO2 100% SpO2 94%. COVID precautions instituted. Received Propofol 150 mg IV and Rocuronium 50 mg IV. Macintosh 4 blade gently inserted into his mouth revealed a grade 2 view. AIROD® gently advanced into oropharynx past vocal cords 4 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. Endotracheal balloon inflated and AIROD® removed intact without any evidence of acute oropharyngeal trauma. Single-handed first-attempt intubation with an 8.0 endotracheal tube performed in 20 seconds.

Case 39

73-year-old 4’9 female 61 kg non-smoker with a past medical history significant for coronary artery disease, diabetes mellitus and end-stage renal failure requiring dialysis via right upper arm fistula complaining of five days of fevers, chills, shortness of breath and worsening cough with headache. COVID-19 screen positive in ED. Transferred to the ICU for Severe ARDS due to SARS CoV-2. ABG 7.37/49/39 on 15 L NC. Chest x-ray multi-lobar consolidations. Received Propofol 150 mg IV and Rocuronium 50 mg IV. Miller 4 blade gently inserted into oropharynx revealed a grade 2 view. AIROD® gently advanced into oropharynx past vocal cords 3 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. Endotracheal balloon inflated and AIROD® removed intact without any evidence of acute oropharyngeal trauma. Single-handed first-attempt intubation with a 7.5 endotracheal tube performed in 16 seconds.

Case 40

58-year-old 5’9 male 71 kg smoker with a past medical history significant for COPD, obstructive sleep apnea, coronary artery disease and diabetes mellitus with multifocal pneumonia on high flow NC 40 L/min FiO2 100% with SpO2 87% and acute tachyarrhythmia heart rate 150. Received Propofol 50 mg IV and Rocuronium 50 mg IV. Miller 4 blade gently inserted into oropharynx revealed a grade 1 view. AIROD® gently advanced into oropharynx past vocal cords 4 cm followed by advancement of the endotracheal tube slowly into the trachea with no assistant holding the AIROD®. Endotracheal balloon inflated and AIROD® removed intact without any evidence of acute oropharyngeal trauma. Single-handed first-attempt intubation with a 8.0 endotracheal tube performed in 12 seconds.

Leave a comment

Please note, comments must be approved before they are published