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Swivel-HEPA-ETT (SHE) bougie and HEPA-ETT (HE) methods for safe intubation while managing patients with COVID-19
  1. Li-Wei Lin1,2,3,
  2. Tzu-Yao Hung3,4,5,6
  1. 1 Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  2. 2 Fu Jen Catholic University, School of Medicine, New Taipei, Taiwan
  3. 3 CrazyatLAB (Critical Airway Training Laboratory), Taipei, Taiwan
  4. 4 Department of Emergency Medicine, Zhong-Xing branch, Taipei City Hospital, Taipei, Taiwan
  5. 5 National Yang Ming University, Taipei, Taiwan
  6. 6 Biomedical Science and Technology, College of Biological science and Technology, National Chiao Tung University, Hsinchu, Taiwan
  1. Correspondence to Dr Tzu-Yao Hung, Emergency, Taipei City Hospital, Zhong-Xing Branch, Taipei 10341, Taiwan; bryansolitude{at}

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Dear Editor,

At the end of December 2019, a novel strain of coronavirus, SARS-CoV-2, was discovered in Wuhan, China. This virus causes the Coronavirus disease COVID-19 that has spread to multiple countries across the world.1 2 The most severely ill patients have required intubation and ventilation, which will likely be performed by emergency physicians and anaesthesiologists. To reduce the risk of aerosol transmission during the intubation, usage of personal protective equipment (PPE, preferably PAPRs (Powered Air-Purifying Respirators)) and video laryngoscopy (VL) are recommended, along with sedation and paralysis of the patient.1–3

Current intubation recommendations for patients with COVID-19 focus on high-efficiency particulate air (HEPA) filter usage connected between the bag valve and the patient mask during preoxygenation. After intubation, the HEPA filter is then disconnected from the bag valve mask and reconnected to the endotracheal tube (ETT).4 5 However, we suggest using a closed system with the HEPA filter already attached to the ETT via either the HEPA-ETT (‘HE’) or ‘Swivel-HEPA-ETT (SHE)-bougie’ methods. The ETT combination with HEPA filter in advance can potentially reduce aerosolisation of the viral droplets from the larynx and trachea during intubation, and the ventilator can then be connected directly to the HEPA filter after intubation. These two methods can also allow for confirmation of ETT placement without auscultation, …

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  • Contributors L-WL invented the original concept and experiment. T-YH designed and organised the concept. L-WL and T-YH edited the manuscript. T-YH did the review of the literature.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.