Endotracheal Intubation of COVID-19 Patients

The novel coronavirus (COVID-19) emerged for the first time in China and then rapidly spread and swept the entire world like a tornado killing thousands of patients around the planet. People were advised to stay in-doors to prevent the spread of this deadly disease, and this slogan helped to a greater extent in containing the spread of the virus (1) . Unfortunately, there is no treatment for the disease at present, but extensive research is going on to find a definitive treatment. Regarding endotracheal intubation (ETI) of COVID-19 patients, data are scarce and no randomized clinical trials are available to develop and formulate succinct and acceptable guidelines in tackling the problem of ETI in these highly risky and vulnerable patients. Zuo et al. provide us with a step-wise approach in intubating the patients with novel coronavirus disease. They emphasized that these patients should be intubated employing the videolaryngoscope (2). In the same vein, Orser BA does not recommend the use of glidescope for all intubations, but rather suggest that anesthetists consider using a glidescope in preference to fiberoptic bronchoscopy in COVID19 patients (3). The use of a glidescope or a similar device is useful but we have some concerns regarding the use of VL based on our own experience from Iran which is probably the worst hit by this deadly disease in The Middle East countries with a high death toll. Although we agree that VL should preferentially be used in intubating COVID-19 patients, nevertheless would like to emphasize that ETI with VL is not always straightforward and easy.