Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis
Background: Tracheal intubation in patients with coronavirus disease-19 is a high-risk procedure that should be performed with personal protective equipment (PPE). The influence of PPE on operator’s performance during tracheal intubation remains unclear. Methods: We conducted a systematic review and...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | Brazilian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001421003560 |
| _version_ | 1811236638583422976 |
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| author | Filippo Sanfilippo Stefano Tigano Valeria La Rosa Alberto Morgana Paolo Murabito Francesco Oliveri Federico Longhini Marinella Astuto |
| author_facet | Filippo Sanfilippo Stefano Tigano Valeria La Rosa Alberto Morgana Paolo Murabito Francesco Oliveri Federico Longhini Marinella Astuto |
| author_sort | Filippo Sanfilippo |
| collection | DOAJ |
| description | Background: Tracheal intubation in patients with coronavirus disease-19 is a high-risk procedure that should be performed with personal protective equipment (PPE). The influence of PPE on operator’s performance during tracheal intubation remains unclear. Methods: We conducted a systematic review and meta-analysis of simulation studies to evaluate the influence of wearing PPE as compared to standard uniform regarding time-to-intubation (TTI) and success rate. Subgroup analyses were conducted according to device used and operator’s experience. Results: The TTI was prolonged when wearing PPE (eight studies): Standard Mean Difference (SMD) -0.54, 95% Confidence Interval [-0.75, -0.34], p < 0.0001. Subgroup analyses according to device used showed similar findings (direct laryngoscopy, SMD -0.63 [-0.88, -0.38], p < 0.0001; videolaryngoscopy, SMD -0.39 [-0.75, -0.02], p = 0.04). Considering the operator’s experience, non-anesthesiologists had prolonged TTI (SMD -0.75 [-0.98, -0.52], p < 0.0001) while the analysis on anesthesiologists did not show significant differences (SMD -0.25 [-0.51, 0.01], p = 0.06). The success rate of tracheal intubation was not influenced by PPE: Risk Ratio (RR) 1.02 [1.00, 1.04]; p = 0.12). Subgroup analyses according to device demonstrated similar results (direct laryngoscopy, RR 1.03 [0.99, 1.07], p = 0.15, videolaryngoscopy, RR 1.01 [0.98, 1.04], p = 0.52). Wearing PPE had a trend towards negative influence on success rate in non-anesthesiologists (RR 1.05 [1.00, 1.10], p = 0.05), but not in anesthesiologists (RR 1.00 [0.98, 1.03], p = 0.84). Trial-sequential analyses for TTI and success rate indicated robustness of both results. Conclusions: Under simulated conditions, wearing PPE delays the TTI as compared to dressing standard uniform, with no influence on the success rate. However, certainty of evidence is very low. Performing tracheal intubation with direct laryngoscopy seems influenced to a greater extent as compared to videolaryngoscopy. Similarly, wearing PPE affects more the non-anesthesiologists subgroup as compared to anesthesiologists. |
| first_indexed | 2024-04-12T12:12:34Z |
| format | Article |
| id | doaj.art-7c95c6cf5e1e49dda66e090fbfb09dd2 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-12T12:12:34Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-7c95c6cf5e1e49dda66e090fbfb09dd22022-12-22T03:33:33ZengElsevierBrazilian Journal of Anesthesiology0104-00142022-03-01722291301Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysisFilippo Sanfilippo0Stefano Tigano1Valeria La Rosa2Alberto Morgana3Paolo Murabito4Francesco Oliveri5Federico Longhini6Marinella Astuto7A.O.U. ''Policlinico-San Marco'', Department of Anaesthesia and Intensive Care, Catania, Italy; Corresponding author.University of Catania, University Hospital ''G. Rodolico'', School of Anaesthesia and Intensive Care, Catania, ItalyUniversity of Catania, University Hospital ''G. Rodolico'', School of Anaesthesia and Intensive Care, Catania, ItalyMagna Graecia University, University Hospital Mater Domini, Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, Catanzaro, ItalyA.O.U. ''Policlinico-San Marco'', Department of Anaesthesia and Intensive Care, Catania, Italy; University of Catania, University Hospital ''G. Rodolico'', School of Anaesthesia and Intensive Care, Catania, Italy; University of Catania, Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, Catania, ItalyA.O.U. ''Policlinico-San Marco'', Department of Anaesthesia and Intensive Care, Catania, ItalyMagna Graecia University, University Hospital Mater Domini, Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, Catanzaro, ItalyA.O.U. ''Policlinico-San Marco'', Department of Anaesthesia and Intensive Care, Catania, Italy; University of Catania, University Hospital ''G. Rodolico'', School of Anaesthesia and Intensive Care, Catania, Italy; University of Catania, Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, Catania, ItalyBackground: Tracheal intubation in patients with coronavirus disease-19 is a high-risk procedure that should be performed with personal protective equipment (PPE). The influence of PPE on operator’s performance during tracheal intubation remains unclear. Methods: We conducted a systematic review and meta-analysis of simulation studies to evaluate the influence of wearing PPE as compared to standard uniform regarding time-to-intubation (TTI) and success rate. Subgroup analyses were conducted according to device used and operator’s experience. Results: The TTI was prolonged when wearing PPE (eight studies): Standard Mean Difference (SMD) -0.54, 95% Confidence Interval [-0.75, -0.34], p < 0.0001. Subgroup analyses according to device used showed similar findings (direct laryngoscopy, SMD -0.63 [-0.88, -0.38], p < 0.0001; videolaryngoscopy, SMD -0.39 [-0.75, -0.02], p = 0.04). Considering the operator’s experience, non-anesthesiologists had prolonged TTI (SMD -0.75 [-0.98, -0.52], p < 0.0001) while the analysis on anesthesiologists did not show significant differences (SMD -0.25 [-0.51, 0.01], p = 0.06). The success rate of tracheal intubation was not influenced by PPE: Risk Ratio (RR) 1.02 [1.00, 1.04]; p = 0.12). Subgroup analyses according to device demonstrated similar results (direct laryngoscopy, RR 1.03 [0.99, 1.07], p = 0.15, videolaryngoscopy, RR 1.01 [0.98, 1.04], p = 0.52). Wearing PPE had a trend towards negative influence on success rate in non-anesthesiologists (RR 1.05 [1.00, 1.10], p = 0.05), but not in anesthesiologists (RR 1.00 [0.98, 1.03], p = 0.84). Trial-sequential analyses for TTI and success rate indicated robustness of both results. Conclusions: Under simulated conditions, wearing PPE delays the TTI as compared to dressing standard uniform, with no influence on the success rate. However, certainty of evidence is very low. Performing tracheal intubation with direct laryngoscopy seems influenced to a greater extent as compared to videolaryngoscopy. Similarly, wearing PPE affects more the non-anesthesiologists subgroup as compared to anesthesiologists.http://www.sciencedirect.com/science/article/pii/S0104001421003560Direct laryngoscopyVideolaryngoscopyAnesthesiologistsParamedicsTime to intubationSuccess rate |
| spellingShingle | Filippo Sanfilippo Stefano Tigano Valeria La Rosa Alberto Morgana Paolo Murabito Francesco Oliveri Federico Longhini Marinella Astuto Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis Brazilian Journal of Anesthesiology Direct laryngoscopy Videolaryngoscopy Anesthesiologists Paramedics Time to intubation Success rate |
| title | Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis |
| title_full | Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis |
| title_fullStr | Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis |
| title_full_unstemmed | Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis |
| title_short | Tracheal intubation while wearing personal protective equipment in simulation studies: a systematic review and meta-analysis with trial-sequential analysis |
| title_sort | tracheal intubation while wearing personal protective equipment in simulation studies a systematic review and meta analysis with trial sequential analysis |
| topic | Direct laryngoscopy Videolaryngoscopy Anesthesiologists Paramedics Time to intubation Success rate |
| url | http://www.sciencedirect.com/science/article/pii/S0104001421003560 |
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