A simple negative-pressure protective barrier for extubation of COVID-19 patients

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

“… 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. Brown and colleagues 33 Letter to the editor Simulation study CPS over Mayo table frame Two experiments, comparing with AB Atomised droplet model using fluorescent dye and qualitative assessment CPS over Mayo frame compared with traditional AB Less spread using CPS over Mayo frame than with traditional AB Hung and colleagues 34 Research letter Simulation study CPS tent + suction system applied N/A CPS tent + suction applied for simulated extubation on mannequin Barrier-enclosure system for extubation Solution to limit the small droplet diffusion out of conventional AB; used successfully in simulation and clinical experience Suresh 35 Letter to the editor Technical report Acrylic AP/CPS tent N/A N/A Barrier-enclosure systems for airway management: AB, CPS tent, and C-ARM cover for anaesthesiologist Suggested use of ‘home-made’ PPE for preserving available resources during the pandemic Puthenveettil and Vijayaraghavan 36 Letter to the editor Technical report Acrylic AB (asymmetric ports) N/A N/A AB for airway management (including nasotracheal intubation and LMA placement) AB is ergonomic because of asymmetric ports; not advised for difficult intubation. Authors recommend this device be used for all patients so that the learning curve can be reached before intubation has to perform actual critical COVID patients.…”

“…All were published between December 1, 2019 and May 27, 2020. There were 19 correspondences, 4e22 16 letters to the editor, 23e33,35e39 10 original articles, 40e49 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.…”

“…It has been argued that physical barriers might be more useful for the extubation phase of airway management, but controlled investigations are likewise needed. 20,34 At the time of anaesthetic emergence, still more questions arise: How will a waking patient react to a confining barrier? What happens in cases of patient coughing after extubation or the need for airway suctioning?…”

“…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.…”

“… 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, ...…”