Acrylic Box Versus Plastic Sheet Covering on Droplet Dispersal During Extubation in COVID-19 Patients

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

“… Sorbello and colleagues 20 Correspondence in response to research letter Commentary CPS N/A CPS over supraglottic airways during CPR Criticism for difficult manipulation, unfeasible position tests, SAD-aided intubation, delay in CPR, and risk of fire Endersby and colleagues 21 Correspondence in response to research letters Simulation study Surgical Mayo stand + C-arm plastic drape N/A Mannequin (?) Detection of Glo Germ fluorescent dye atomised by laryngotracheal mucosal atomisation device to simulate the production of fine droplets and aerosol Without barrier, Glo Germ identified on the laryngoscopist's hands, arms, gown, neck, face, eye protection, mask, and extended spread around the OT Laosuwan and colleagues 22 Correspondence Simulation study AB (3 configurations); CPS Five simulations for each configuration (AB1, AB2, AB3, CPS, and no barrier) in simulated extubation Self-designed droplet-generating device with fluorescent dye used to compare three AB configurations (number of stained 5×5 squares outside the boxes: around the mannequin, on the chest of the mannequin, and on the anaesthetist's gown and face shield Overall droplet dispersion: acrylic AB models (3.3–19.0%), CPS (2.8%), and non-coverage technique (26.3%); all AB showed no contamination on anaesthesia personnel; CPS caused contamination both on the chest and abdomen of anaesthetist (self-contamination) Brown and colleagues 23 Letter to the editor Clinical report CPD on bag barrier system N/A Mannequin and patients Application of CPD on bag barrier system for airway management Economic and intubation feasible, including assistant's help; proposed removal of the clear drape during mid-laryngoscopy in case of difficulty Leyva Moraga and colleagues 24 Letter to the editor Clinical report AB Five patients N/A Application of AB for intubation/extubation AB has proved to be a valuable resource functioning as an adaptive tool to aid in resource-limiting setting. The AB did not represent an obstacle to established protocol, acting as feasible solution in low- and middle-income healthcare settings.…”

“…As alluded to above, the issue of aerosol viral particle load within the confines of a barrier and its release on removal ('secondary aerosolisation') will need to be addressed. 22,70 In parallel with the observation of increased contamination risk during PPE doffing, 78 we might inadvertently create a 'secondary aerosolisation' risk upon barrierenclosure removal. 30 What effect may barriers have on the use of adequate PPE?…”

“…5,16,17,32,41,42,46,55,59,60 Website report Advantages and disadvantages Sample sizes were often not given. 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.…”

“…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.…”

Intraoperative aerosol box use: does an educational visual aid reduce contamination?

“…Simulation studies have demonstrated the effectiveness of aerosol boxes in preventing droplet spread [12][13][14], but concerns exist regarding clinical effectiveness in aerosol prevention and possible unintended complications with their use [8,[15][16][17][18]. Due to the rapid development and dissemination of this medical device, no formal instructions or guidelines for use exist.…”