Will Protective Innovations Like the “Airway Box” Become Routine Practice After the Pandemic?: An Opinion Survey

Ellison, Pavithra R; Nanners, Benton; Schaefer, Gregory; Krueger, Austin M; Dhumak, Vipul; Shepherd, Jason L; Nguyen, Khoa Huu; Allen, Kathrin; Ellison, Matthew

doi:10.7759/cureus.13258

Cited by 3 publications

(7 citation statements)

References 12 publications

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“…Additionally, the structured qualitative evaluation conducted through the use of a questionnaire identifies specific concerns based on direct provider experience. Interestingly, a study by Ellison et al, which evaluated the use of an aerosol box in clinical use for emergent intubations, reported that the majority of practitioners who used the device found it easy to use, although it was rarely used despite being a readily available option [20].…”

Section: Strengths Limitations and Future Directionsmentioning

confidence: 99%

Evaluating the Use of an Aerosol Box During Simulated Intubations

Lima¹,

Chen²,

Abbas³

et al. 2021

Cureus

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To evaluate the use of an aerosol box during video laryngoscopy intubation, we conducted a twophase simulation-based study to assess if there were significant differences in time needed to safely intubate a patient with an aerosol box in place, as well as assess changes in laryngoscopists' hand motions as determined by changes in accelerometry. 20 anesthesiology providers from our institution participated in the first phase assessing the time to intubation. Use of the aerosol box led to statistically significant increases in intubation times (Wilcoxon-Signed Rank test p < 0.001, z-score = 3.921), with the calculated Pearson's correlation coefficient (r = 0.877) indicating a large effect size. An 8.5 -11.5 second difference in median intubation times was maintained between corresponding attempts with versus without the aerosol box. 15 participants completed an optional post-assessment survey, with 10 of 15 respondents firmly stating they would not use the box in clinical practice. The hand accelerometry assessment included five anesthesiology providers from our institution. This revealed a statistically significant increase in trials with aerosol boxes for the left hand's general accelerometry with a medium effect size (p = 0.031; z = -1.873; r = -0.484), as well as for the right hand's general accelerometry with a large effect size (p < 0.001; z = -3.351; r = -0.865). Although the aerosol box is an interesting concept, its use is associated with increased time to intubation and a change in ergonomics, which may increase risk during airway management and represents a concern for patient safety.

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Section: Strengths Limitations and Future Directionsmentioning

confidence: 99%

Evaluating the Use of an Aerosol Box During Simulated Intubations

Lima¹,

Chen²,

Abbas³

et al. 2021

Cureus

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“…The aerosol box was designed to mitigate HCP infection by providing a physical barrier to minimize exposure to aerosols . This study showed that aerosol box use reduces surface contamination on the PPE (torso and face) of airway practitioners after performing AGMPs.…”

Section: Discussionmentioning

confidence: 97%

“…The aerosol box has been implemented by some hospitals worldwide for management of COVID-19 patients who are critically ill . Studies demonstrate that aerosol box use potentially reduces spread of aerosolized particles, but is often associated with technical challenges .…”

Section: Introductionmentioning

confidence: 99%

“…The aerosol box has been implemented by some hospitals worldwide for management of COVID-19 patients who are critically ill. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 Studies demonstrate that aerosol box use potentially reduces spread of aerosolized particles, 20 , 21 but is often associated with technical challenges. 22 , 23 , 24 , 25 Simulation-based studies describe delayed time to intubation with aerosol box use, but clinical studies largely demonstrate no difference in intubation times.…”

Section: Introductionmentioning

confidence: 99%

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Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

et al. 2023

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ImportanceThe aerosol box has been used during the management of patients with COVID-19 to reduce health care practitioner (HCP) exposure during aerosol-generating medical procedures (AGMPs). Little is known about the effect of aerosol box use on HCP contamination and AGMP procedure time.ObjectiveTo investigate whether use of an aerosol box during AGMPs reduces HCP contamination or influences the time to successful completion and first-pass success rate for endotracheal intubation (ETI) and laryngeal mask airway (LMA) insertion.Design, Setting, and ParticipantsThis multicenter, simulation-based, randomized clinical trial was conducted from May to December 2021 at tertiary care pediatric hospitals. Participant teams performed 3 simulated patient scenarios: bag-valve-mask ventilation, ETI, and LMA insertion. During the scenarios, aerosols were generated using Glo Germ. Teams of 2 HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Statistical analysis was performed from July 2022 to February 2023.InterventionsThe aerosol box (or SplashGuard CG) is a transparent, plastic barrier covering the patient’s head and shoulders with access ports allowing HCPs to manage the airway.Main Outcomes and MeasuresThe primary outcome was surface area of contamination (AOC) on participants. Secondary outcomes were time to successful completion and first-pass success rates for ETI and LMA insertion.ResultsA total of 64 teams (128 participants) were enrolled, with data from 61 teams (122 participants) analyzed. Among the 122 participants analyzed, 79 (64.8%) were female and 85 (69.7%) were physicians. Use of an aerosol box was associated with a 77.5% overall decreased AOC to the torso (95% CI, −86.3% to −62.9%; P &lt; .001) and a 60.7% overall decreased AOC to the facial area (95% CI, −75.2% to −37.8%; P &lt; .001) in airway HCPs. There was no statistically significant difference in surface contamination after doffing personal protective equipment between groups. Time to completing ETI was longer in the aerosol box group compared with the control group (mean difference: 10.2 seconds; 95% CI, 0.2 to 20.2 seconds; P = .04), but there was no difference between groups for LMA insertion (mean difference: 2.4 seconds; 95% CI, −8.7 to 13.5 seconds; P = .67).Conclusions and RelevanceIn this randomized clinical trial of aerosol box use in AGMPs, use of an aerosol box reduced contamination deposition on HCPs’ torso and face predoffing; the use of an aerosol box delayed time to successful intubation. These results suggest that the incremental benefits of reduced surface contamination from aerosol box use should be weighed against delayed time to complete intubation, which may negatively affect patient outcome.Trial RegistrationClinicalTrials.gov Identifier: NCT04880668

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“…However, in emergency and intensive care, these procedures are often essential for patient treatment and survival, and any delay in their implementation would be a detriment to the patients. Since the beginning of the COVID-19 pandemic, there have been many reports of the use of aerosol boxes, with the aim being to reduce aerosol dispersion, thereby preventing secondary infections among HCPs [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

A Dome-Shaped Aerosol Box for Protection During a Pandemic

Ueno¹,

Iseki²,

Suzuki³

et al. 2022

Cureus

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With the rise of COVID-19, the use of aerosol boxes when interacting with COVID-19 patients has increased. However, their use has been controversial.We have been involved in the development of a dome-shaped aerosol containment device with negative pressure (DAWN), an aerosol box that can maintain negative pressure inside at all times.There are two types of DAWN: one is mounted on a bed (bed type) and the other is mounted on a stretcher (stretcher type). Each device has its own characteristics and can be selected depending on the situation. The bed type has enough space inside to allow procedures to be performed easily. The stretcher type can be attached to a stretcher and can maintain negative pressure when the patient is being moved. Due to the negative pressure structure and easy change of nonwoven fabric adopted in both types of DAWN, it is expected to prevent the scattering of aerosol when it is removed, which is a problem of conventional aerosol boxes.DAWN will contribute to reducing the enormous psychological stress of medical personnel who treat infections, and will contribute to reducing aerosol dispersion.

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Will Protective Innovations Like the “Airway Box” Become Routine Practice After the Pandemic?: An Opinion Survey

Cited by 3 publications

References 12 publications

Evaluating the Use of an Aerosol Box During Simulated Intubations

Evaluating the Use of an Aerosol Box During Simulated Intubations

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

A Dome-Shaped Aerosol Box for Protection During a Pandemic

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