UVL - i-view infection control benefits and COVID-19


	i-view infection control benefits The Association of Anaesthetists produced a guidance document, entitled, ‘Guidelines – Infection prevention and control 2020’, (published before the COVID-19 outbreak) which comments directly on video laryngoscopes in the context of infection control, confirming that, ‘Single-use video laryngoscopes minimise any chance of cross contamination and would be ideal, but many single-use video laryngoscopes have reusable components that need to be decontaminated after each use.¹This is correct, since many devices incorporate single use blades, but still have reusable screens, monitors and handles. However, a completely single use and fully integrated disposable video laryngoscope is available to the clinician – the i-view™. i-view™ offers the clinician a genuinely single use option for video laryngoscopy, reducing the potential risk of transmission during intubation compared to a conventional direct laryngoscope, eliminating any potential risks associated with the reprocessing of reusable devices and minimising the risk of cross contamination.		i-view™ and COVID-19 The consensus guidelines for managing the airway in patients with COVID-19², confirm that, ‘where practical, ‘single use equipment should be used’.
			Of course, there are caveats to this, particularly where quality may vary between devices and no comment is made specifically in relation to video laryngoscopes. However, with guidelines such as these highlighting the benefits of using a video laryngoscope for tracheal intubation during the pandemic and a recognition that where practical, single use equipment should be used, i-view™ offers the clinician a genuinely single use option for video laryngoscopy, eliminating any potential risks associated with the reprocessing of reusable devices, and reducing the potential risk of transmission during intubation compared to a conventional direct laryngoscope. There is now also published evidence to support the use of i-view™ with patients who have COVID-19 in the form of a letter to the editor of Minerva Anestesiologica, entitled, ‘Emergency tracheal intubation in COVID-19 patients with the i-view video laryngoscope’³ published in December 2020. The authors retrospectively reported on the performance of the i-view™ on a series of twenty patients with COVID-19 requiring intubation. Data was recorded for duration of intubation (power on to first CO₂ detection), number of intubation attempts, outcome, Freemantle score, use of airway adjuncts, whether cricoid force was applied, rescue technique in case of failure, lowest saturation and complications were all recorded. In addition, a satisfaction score was included with a visual analogue scale (VAS) ranking from 1 (no satisfaction) to 4 (maximum satisfaction). There were no failures, with 18/20 first pass success and 2/20 second pass success. Mean intubation time was <2 minutes in all cases. The Freemantle score was 17/20 with a full view and 3/20 with a partial view. The VAS satisfaction score was 4 (maximum satisfaction) for 18/20 cases and 3 for 2/20 cases. Whilst the debate as to which is the best video laryngoscope has yet to be resolved, the authors of this letter concluded that, ‘the possibility of having a completely (including screen) disposable and readily available device makes i-view™ a potential candidate as optimal choice VL.’ Whilst acknowledging that more data is required to draw any conclusions, ‘we may hope that a good beginning bodes well’. In conclusion, initial clinical evidence on the use of i-view™ for patients with COVID-19 is encouraging, further supporting its use where there is a concern regarding infection control, including for patients with COVID-19.
	References 1. Bailey C.R, Greatorex B, Hyde Y, Koerner R, McGuire N, Meek T, Radhakrishna S. Infection prevention and control 2020 [Internet]. Association of Anaesthetists. Association of Anaesthestists; 2020 [cited 2021 Jan 07]. Available from: https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/Infection_Control_Guideline_FINAL%202020.pdf?ver=2020-01-20-105932-143 2. Cook T.M, El-Boghdadly K, McGuire B, McNarry A.F, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists, the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020; 75: 785-99 3. Corso R.M, Cortese G, Cataldo R, Di Giacinto I, Sgalambro F, Terzitta M, Aiello L, Maitan S, Sorbello M. Emergency tracheal intubation in COVID-19 patients with the I-view videolaryngoscope. Minerva anestesiologica 2020; 15265-9