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In 2035, a new class of highly infectious respiratory viruses plagues the world with severe multiorgan failure and high mortality. Scientists race against viral mutations with vaccines and boosters, but supplies are in dire shortage. Personal protective equipment (PPE) has been depleting rapidly due to overwhelming surge of patients and critical disruptions in the global supply and manufacturing chain.
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As an anesthesiologist in a regional hospital a few hours away from the tertiary hospitals, you cover a wide area of rural and remote communities. On a stormy night, you receive a video call from the paramedics. They are in a remote area, in the home of Mr. A, a 40-year-old morbidly obese patient with a suspected respiratory infection. Due to weather constraints, the paramedics must rely on ground transport, and it will take a few hours to bring the patient by ambulance to the regional hospital due to poor visibility and road conditions. Since the paramedics arrived, the patient’s condition has been deteriorating with increasing oxygen requirements and decreasing saturation, despite a trial of noninvasive ventilation, and the paramedics think it would be prudent to secure the airway prior to the drive.
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The patient has multiple predictors of challenging intubation, usage of an extraglottic airway, and front-of-neck airway (FONA) access. He is extremely anxious and agitated due to his difficulty in breathing and has limited physiologic reserve. Moreover, while the paramedics have PPE, there remains concerns about viral transmission through aerosolization during tracheal intubation, especially if multiple attempts are needed. You assess the situation and ask the paramedics to prepare for robotic intubation using a flexible bronchoscope with the patient lightly sedated and spontaneously breathing. You also instruct them to set up backup airway equipment, optimize the position of the patient, denitrogenate, topicalize the airway, administer necessary medications, and deploy the remote-controllable intubation robot.
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The intubation robot has some difficulty with automated movements initially due to the excessive airway tissues and secretions, but you guide it through properly from your regional hospital using a joystick. The robot navigates the rest of the way automatically. It identifies the vocal cords, sprays the vocal cords with local anesthetic, and inserts the tracheal tube. The paramedics secure the tracheal tube in place and connected the transport ventilator, and transport the patient sedated to your regional hospital. Along the way, you check in to provide any support they need.
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What Are Robotics and Artificial Intelligence, and What Are Their Potential Clinical Applications in Airway Management?
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Robots are systems that process information into action in the physical world. Although robotic systems were first widely deployed in industrial applications1, their potential for use is service applications (including health care) has been recognized since at least the 1980s.2 Since then, robotic systems have been increasingly integrated into surgery and interventional medicine,...