Prevention is better than the cure, but the cure cannot be worse than the disease: fibreoptic tracheal intubation in COVID-19 patients.

Airway management is complex in COVID-19 patients (infection risk, use of personal protective equipment (PPE), difficult communication, rapidly deteriorating patients, and shunt–hypoxaemia). Given the duration, complexity, and aerosolisation potential of fibreoptic intubation and the potential low-efficacy/high contamination profile of HFNO, we strongly discourage the use of the technique proposed by Wu and colleagues1 in paralysed COVID-19 patients. Awake fibreoptic intubation remains the gold standard for predicted intubation/ventilation difficulty to be used in very selected cases in COVID-19 patients.2 , 8 , 9 Oxygenation, independently of disease, remains the main target of any airway management strategy,5 and although difficult at times, science and good sense should always prevail.