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Factors affecting providers’ comfort and fear during intubations of patients with COVID-19
  1. Esther Lee1,
  2. Reem Qabas Al Shabeeb2,
  3. Muhammad El Shatanofy3,
  4. Collin F Mulcahy4,
  5. David P Yamane5,6,
  6. Marian L Sherman5,
  7. Eric R Heinz5
  1. 1 Western University of Health Sciences, Pomona, California, USA
  2. 2 Internal Medicine, Inova Fairfax Hospital, Falls Church, Virginia, USA
  3. 3 The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  4. 4 Division of Otolaryngology–Head and Neck Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  5. 5 Department of Anesthesiology and Critical Care, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  6. 6 Department of Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
  1. Correspondence to Esther Lee, Western University of Health Sciences, Pomona, CA CA 91766, USA; esther.lee1{at}


Background Providers performing endotracheal intubation are at high risk of contracting SARS-CoV-2. The objective was to assess various demographic, exposure and institutional preparedness factors affecting intubators’ comfort and fear level during COVID-19 intubations.

Methods We conducted a cross-sectional, survey-based study during the COVID-19 pandemic from September 2020 to January 2021 at a single academic medical centre in Washington, DC, USA. Inclusion criteria were healthcare providers who had an experience in intubating patients confirmed with or suspected of COVID-19. The survey assessed various factors related to the providers’ comfort with intubation and fear during COVID-19 intubations.

Results A total of 329 surveys from 55 hospitals were analysed. Of the respondents, 173 (52.6%) were from emergency medicine providers. Factors that were associated with a higher comfort level of intubating patients with COVID-19 included attending physician position (adjusted OR (aOR)=2.6, 95% CI 1.4 to 4.8; p=0.003), performing more than 20 COVID-19 intubations (aOR=3.3, 95% CI 1.5 to 6.6; p=0.002), participation in an intubation team (aOR=1.6, 95% CI 1.1 to 2.7; p=0.031) and adequate levels of personal protective equipment (PPE) (aOR=4.3, 95% CI 2.0 to 8.8; p<0.0005). Compared with emergency physicians, anaesthesiology providers had higher fear levels of contracting SARS-CoV-2 during both first and subsequent SARS-CoV-2 intubations (first: OR=1.7, 95% CI 1.1 to 2.6, p=0.006; subsequent: OR=2.0, 95% CI 1.4 to3.2, p<0.0005).

Conclusion A higher degree of comfort in intubating patients suspected of or confirmed with COVID-19 was demonstrated in more senior physicians, members of intubation teams, providers who performed a higher number of intubations and providers who reported adequate PPE. These findings highlight potential targets for improving the experience of providers in this setting.

  • COVID-19

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  • Handling editor Ed Benjamin Graham Barnard

  • Contributors DPY is the guarantor and the corresponding author of this work. All authors substantially contributed to the study design and reviewed and commented on the manuscript. All authors have full access to the data in this study. EL, IB and ERH analysed the data and take responsibility for the integrity of the data and the accuracy of the data analysis. RQAS, EL and CFM wrote the first draft of this article.

  • 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, conduct, reporting or dissemination plans of this research.

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