Effect of two barrier devices on the time taken and ease of intubation of a paediatric intubation manikin - A randomised cross-over simulation study

BACKGROUND AND AIMS: During the present COVID-19 pandemic, several inventions have been employed to protect personnel involved in intubation from inhalational exposure to the virus. In this study, we compared the effect of two barrier devices, Intubation Box versus Plastic Drape, on the time taken and difficulty in intubating a pediatric manikin. MATERIAL AND METHODS: Nineteen experienced anesthesiologists performed six different intubations: without barrier, with intubation box, with plastic drape; with and without a bougie, using the Latin Square Design for randomizing order of intubations. The time taken for intubation (TTI) was compared using Student’s t test, and nonparametric values were analyzed using Chi-square test with Yates correction. RESULTS: Both barrier devices increased the TTI from 14.8 (3.5) s to 19.8 (6.8) s with intubation box (P = 0.068) and 19.3 (8.9) s with plastic drape (P = 0.099). Use of bougie significantly prolonged TTI to 25.8 (6.7) s without barrier (P = 0.000), 32.5 (13.3) with intubation box (P = 0.000), and 29.8 (7.3) s with plastic drape (P = 0.000). The number of attempts was not different (P = 0.411), and the visibility was slightly impaired with both barriers (P = 0.047). The ease of intubation, even without the bougie, was significantly different compared to default, with P values of 0.009 and 0.042 for intubation box and plastic drape, respectively. The highest significance was with intubation box with bougie with a P value of 0.00017. CONCLUSION: Both the intubation box and plastic drape increased the time taken as well as difficulty in intubation. The extra protection afforded should be balanced against risks of hypoxia in the patient.