My son in law also made the point that the most serious time when the virus is disseminated is at the time of intubation as the fomites are released into the air. As a result unless the OR has negative pressure room ventilation they will not do an intubation under those circumstances due to the high risk of them acquiring the virus. In the ICU the circulation is negative pressure and if a patient with covid requires emergency surgery the intubation is done in the ICU in a hazmat outfit and is then transported to the OR for surgery.
Interesting. I couldn't agree more. But we don't go to that extreme. If intubating a Covid for OR, rather than for ICU care, we limit the number of people in OR to 3 ( patient, anaesthesia and tech). The intubation are done by the MOST SENIOR anaesthetists available , and being done all with videoscope ( normally I almost never use them). Reason- trying to give the optimal chance of getting tube in right pipe first time. Theatre staff enter once tube in.As far as I know, the guys are using rocuronium for almost all intubations ( I just mention it because it causes more anaphylaxis cases than any agent I've ever used). I would also hazard a guess that your son in law is taking as much care at time of extubation- coughing there just as dangerous if not more so. the guys here are extubating all deep , or using remifentanil. In the unit, when I tube, I do something similar but not all done in negative pressure rooms. If I have one , I'll wear a N95 mask plus PPE but until yesterday we didn't have any N95's.
The renal failure is interesting- we're seeing it but we saw that with bad multi organ failure prior to Covid. If they need rinsing we just get on and do it.