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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...

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Autores principales: Abolkheir, Abdullah B., El-Kabbani, Ahmed, Al Raffa, Abdullah, AlFattani, Areej, Norris, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477778/
https://www.ncbi.nlm.nih.gov/pubmed/34658726
http://dx.doi.org/10.4103/sja.sja_274_21
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author Abolkheir, Abdullah B.
El-Kabbani, Ahmed
Al Raffa, Abdullah
AlFattani, Areej
Norris, Andrew
author_facet Abolkheir, Abdullah B.
El-Kabbani, Ahmed
Al Raffa, Abdullah
AlFattani, Areej
Norris, Andrew
author_sort Abolkheir, Abdullah B.
collection PubMed
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.
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spelling pubmed-84777782021-10-15 Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study Abolkheir, Abdullah B. El-Kabbani, Ahmed Al Raffa, Abdullah AlFattani, Areej Norris, Andrew Saudi J Anaesth Original Article 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. Wolters Kluwer - Medknow 2021 2021-09-02 /pmc/articles/PMC8477778/ /pubmed/34658726 http://dx.doi.org/10.4103/sja.sja_274_21 Text en Copyright: © 2021 Saudi Journal of Anaesthesia https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Abolkheir, Abdullah B.
El-Kabbani, Ahmed
Al Raffa, Abdullah
AlFattani, Areej
Norris, Andrew
Comparative performance of two protective barriers during tracheal intubation of COVID-19 patients: A simulation cross-over study
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 Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477778/
https://www.ncbi.nlm.nih.gov/pubmed/34658726
http://dx.doi.org/10.4103/sja.sja_274_21
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