A Protection Tent for Airway Management in Patients With COVID-19 Infection

Fang, Pin Hui; Lin, Yu Fang; Lin, Chih Hao

doi:10.1016/j.annemergmed.2020.04.004

Cited by 11 publications

(16 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… Mannequin and patients Use of total-body CPS for airway management Economic; intubation feasible; also for transport Scapigliati and colleagues 28 Letter to the editor Technical report CPS N/A CPS over SAD during CPR in mannequin model Hypothesis of aerosol limitation when using SAD during CPR; measurement of differential inspiration/expiration with spirometer during simulated mechanical ventilation Hypothesis of efficacy Patino Montoya and Chitilian 29 Letter to the editor Technical report CPS with midline slit N/A CPS sealed to tracheal tube to prevent aerosolisation and droplets during extubation Use of CPS for extubation The CPS blocks the dispersion of aerosolised particles during extubation. Rosenblatt and Sherman 30 Letter to the editor Commentary AB N/A N/A N/A Restrictions in movement and limitations in emergency; heavy for carrying/moving; issues with cleaning Fang and colleagues 31 Letter to the editor Technical report Frame and CPS N/A Patients? Construction of enclosure barrier Economic, flexible, and lightweight Swart and Strydom 32 Letter to the editor Simulation study Plastic AB + CPS + suction tube One experiment in four steps Optical evaluation of smoke spreading Home-made smoke source to explore AB retaining capacity AB effectively limits aerosol spread qualitatively, but even adding suction and CPS covering AB does not prevent the escape of aerosol, especially when the internal volume is accessed through arm holes.…”

Section: Resultsmentioning

confidence: 99%

“…5,6,8e11,13,14,17e21,23,25e27,29e31,33,40,41,46,48,52,53,57,58 Cases of barrier-enclosure use with one mannequin or one human were noted in eight reports, 12,15,16,42,50,54,62,63 five cases in three reports, 22,24,44 and series of 25 or more cases in three reports. 37,45,47 The reported settings were simulations with mannequins in 20 cases, 4e6,11e13, 16,19,21e23,25e28,39,41,45,49,60 simulations with study volunteers in two cases, 9,51 use in adult patients in 11 cases, 7,15,23,27,31,37,42,44,47,50,55 and four in paediatric patients. 41,43,52,56 In 24 reports, there was either no setting described or there was a barrier-enclosure description without demonstration.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…All were published between December 1, 2019 and May 27, 2020. There were 19 correspondences, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 16 letters to the editor, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 10 original articles, 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 three research letters, 34 , 50 , 51 one guideline, 52 one short recommendation, 53 one case report, 54 and one quality improvement study. 55 Of these reports, there were only six case reports or small case series.…”

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

“… 55 Of these reports, there were only six case reports or small case series. 6 , 15 , 42 , 43 , 44 , 54 The most common barrier-enclosure types were plastic wraps or tents (25 reports), 5 , 9 , 12 , 15 , 17 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 31 , 33 , 34 , 38 , 39 , 41 , 42 , 44 , 46 , 47 , 52 , 54 , 56 acrylic aerosol boxes (19 reports), 4 , 5 , 6 , 8 , 11 , 15 , 16 , 18 , 19 , 22 , 24 , 35 , 36 , 43 , 45 , 51 , 53 , 57 , 58 and combinations of aerosol boxes and plastic wraps (eight reports). 6 , 8 , 13 , 15 , 32 , 37 , 43 , 49 Eleven reports included other types of barrier enclosures (modified incubator hood, ...…”

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

“… 5 , 6 , 8 , 9 , 10 , 11 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 23 , 25 , 26 , 27 , 29 , 30 , 31 , 33 , 40 , 41 , 46 , 48 , 52 , 53 , 57 , 58 Cases of barrier-enclosure use with one mannequin or one human were noted in eight reports, 12 , 15 , 16 , 42 , 50 , 54 , 62 , 63 five cases in three reports, 22 , 24 , 44 and series of 25 or more cases in three reports. 37 , 45 , 47 The reported settings were simulations with mannequins in 20 cases, 4 , 5 , 6 , 11 , 12 , 13 , 16 , 19 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 39 , 41 , 45 , 49 , ...…”

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

See 4 more Smart Citations

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Sorbello

Rosenblatt

Hofmeyr

et al. 2020

British Journal of Anaesthesia

113

View full text Add to dashboard Cite

Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/ confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fiftytwo articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

See 3 more Smart Citations

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Sorbello

Rosenblatt

Hofmeyr

et al. 2020

British Journal of Anaesthesia

113

View full text Add to dashboard Cite

show abstract

Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic

Turer

Good

Schilling

et al. 2021

Annals of Emergency Medicine

View full text Add to dashboard Cite

Study objective Throughout the coronavirus disease 2019 pandemic, many emergency departments have been using passive protective enclosures (“intubation boxes”) during intubation. The effectiveness of these enclosures remains uncertain. We sought to quantify their ability to contain aerosols using industry standard test protocols. Methods We tested a commercially available passive protective enclosure representing the most common design and compared this with a modified enclosure that incorporated a vacuum system for active air filtration during simulated intubations and negative-pressure isolation. We evaluated the enclosures by using the same 3 tests air filtration experts use to certify class I biosafety cabinets: visual smoke pattern analysis using neutrally buoyant smoke, aerosol leak testing using a test aerosol that mimics the size of virus-containing particulates, and air velocity measurements. Results Qualitative evaluation revealed smoke escaping from all passive enclosure openings. Aerosol leak testing demonstrated elevated particle concentrations outside the enclosure during simulated intubations. In contrast, vacuum-filter-equipped enclosures fully contained the visible smoke and test aerosol to standards consistent with class I biosafety cabinet certification. Conclusion Passive enclosures for intubation failed to contain aerosols, but the addition of a vacuum and active air filtration reduced aerosol spread during simulated intubation and patient isolation.

show abstract