Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study
COVID-19 was declared a pandemic by the WHO in 2020. In light of the global shortage of PPE and concerns regarding the safety of healthcare providers, clinicians have resorted to the use of novel protective barriers, such as aerosol boxes and plastic sheets, during aerosol generating procedures, esp...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Saudi Journal of Anaesthesia |
| Subjects: | |
| Online Access: | http://www.saudija.org/article.asp?issn=1658-354X;year=2021;volume=15;issue=4;spage=396;epage=402;aulast=Abolkheir |
| _version_ | 1830191816685649920 |
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| author | Abdullah B Abolkheir Ahmed El-Kabbani Abdullah Al Raffa Areej AlFattani Andrew Norris |
| author_facet | Abdullah B Abolkheir Ahmed El-Kabbani Abdullah Al Raffa Areej AlFattani Andrew Norris |
| author_sort | Abdullah B Abolkheir |
| collection | DOAJ |
| description | COVID-19 was declared a pandemic by the WHO in 2020. In light of the global shortage of PPE and concerns regarding the safety of healthcare providers, clinicians have resorted to the use of novel protective barriers, such as aerosol boxes and plastic sheets, during aerosol generating procedures, especially tracheal intubation. We compared the effect of these barriers on the tracheal intubation of simulated patients with severe COVID-19 in a crossover study. The study was approved by the Ethics Committee of King Faisal Specialist Hospital, and the procedures were compliant with the COVID-19 airway management guidelines of the Saudi Anesthesia Society. The time to intubation was our primary outcome. Secondary outcomes included number of optimization maneuvers, number of intubation attempts, time to glottic view and ventilation of the lungs, and damage to PPE. Thirteen consultant anesthetists performed 39 tracheal intubations on a manikin using each of three approaches (aerosol box, plastic sheet, and no-barrier). Data were collected via direct and video observation. The plastic sheet approach demonstrated the highest time to intubation (mean ± StE [95% CI]: 33.3s ± 3.5 [25.8– 40.9]) compared to the aerosol box (22.0s ± 2.5 [16.5 – 27.5], P < 0.01) and no-barrier approaches (16.1s ± 1.1 [13.7 – 18.4], P < 0.0001). Similarly, the plastic sheet approach had the highest time to glottic view, and ventilation intervals compared to the other two approaches, while the no-barrier approach had the shortest time intervals. There were no failed intubations or damage to the PPE sustained during the use of any of the three approaches. The aerosol box does not impose a significant delay in tracheal intubation using video laryngoscopy, unlike the plastic sheet barrier. Further research on the aerosolization risk is warranted before these protective barriers can be considered as mainstay approaches during aerosol generating procedures. |
| first_indexed | 2024-12-17T23:44:17Z |
| format | Article |
| id | doaj.art-381cf0883f7c4ab38b118fa1ba104727 |
| institution | Directory Open Access Journal |
| issn | 1658-354X |
| language | English |
| last_indexed | 2024-12-17T23:44:17Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj.art-381cf0883f7c4ab38b118fa1ba1047272022-12-21T21:28:21ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X2021-01-0115439640210.4103/sja.sja_274_21Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over studyAbdullah B AbolkheirAhmed El-KabbaniAbdullah Al RaffaAreej AlFattaniAndrew NorrisCOVID-19 was declared a pandemic by the WHO in 2020. In light of the global shortage of PPE and concerns regarding the safety of healthcare providers, clinicians have resorted to the use of novel protective barriers, such as aerosol boxes and plastic sheets, during aerosol generating procedures, especially tracheal intubation. We compared the effect of these barriers on the tracheal intubation of simulated patients with severe COVID-19 in a crossover study. The study was approved by the Ethics Committee of King Faisal Specialist Hospital, and the procedures were compliant with the COVID-19 airway management guidelines of the Saudi Anesthesia Society. The time to intubation was our primary outcome. Secondary outcomes included number of optimization maneuvers, number of intubation attempts, time to glottic view and ventilation of the lungs, and damage to PPE. Thirteen consultant anesthetists performed 39 tracheal intubations on a manikin using each of three approaches (aerosol box, plastic sheet, and no-barrier). Data were collected via direct and video observation. The plastic sheet approach demonstrated the highest time to intubation (mean ± StE [95% CI]: 33.3s ± 3.5 [25.8– 40.9]) compared to the aerosol box (22.0s ± 2.5 [16.5 – 27.5], P < 0.01) and no-barrier approaches (16.1s ± 1.1 [13.7 – 18.4], P < 0.0001). Similarly, the plastic sheet approach had the highest time to glottic view, and ventilation intervals compared to the other two approaches, while the no-barrier approach had the shortest time intervals. There were no failed intubations or damage to the PPE sustained during the use of any of the three approaches. The aerosol box does not impose a significant delay in tracheal intubation using video laryngoscopy, unlike the plastic sheet barrier. Further research on the aerosolization risk is warranted before these protective barriers can be considered as mainstay approaches during aerosol generating procedures.http://www.saudija.org/article.asp?issn=1658-354X;year=2021;volume=15;issue=4;spage=396;epage=402;aulast=Abolkheiraerosol boxaerosol generating procedurescoronavirusmanikintracheal intubationvideo-laryngoscope. |
| spellingShingle | Abdullah B Abolkheir Ahmed El-Kabbani Abdullah Al Raffa Areej AlFattani Andrew Norris Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study Saudi Journal of Anaesthesia aerosol box aerosol generating procedures coronavirus manikin tracheal intubation video-laryngoscope. |
| title | Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study |
| title_full | Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study |
| title_fullStr | Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study |
| title_full_unstemmed | Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study |
| title_short | Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study |
| title_sort | comparative performance of two protective barriers during tracheal intubation of covid 19 patients a simulation cross over study |
| topic | aerosol box aerosol generating procedures coronavirus manikin tracheal intubation video-laryngoscope. |
| url | http://www.saudija.org/article.asp?issn=1658-354X;year=2021;volume=15;issue=4;spage=396;epage=402;aulast=Abolkheir |
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