Additional Barrier to Protect Health Care Workers During Intubation

Babazade, Rovnat; Khan, Ejaz; Ibrahim, Mohamed; Simón, M.; Vadhera, Rakesh

doi:10.1213/ane.0000000000004904

Cited by 9 publications

(18 citation statements)

References 1 publication

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“… Yang and colleagues 25 Letter to the editor Technical report CPS with incisions and tape reinforce N/A Mannequin? Use of modified CPS for intubation and extubation (left in place) Modification aimed to improve laryngoscopic manoeuvring; multi-layer option Babazade and colleagues 26 Letter to the editor Technical report CPS with cross-cut N/A Mannequin? Use of modified CPS for airway management Economic; intubation feasible Rehm and colleagues 27 Letter to the editor Clinical report Full-body CPS N/A (60 patients?)…”

Section: Resultsmentioning

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%

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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

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

See 1 more Smart Citation

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

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“…Multiple articles regarding the perioperative safety for health care workers dealing with COVID-19 patients have been published recently, 3,4 including one proposing use of an aerosol box for intubation in areas of inadequate personal protective equipment (PPE). 5 Canelli et al 5 did a simulation study by inducing cough using fluorescent dye and suggested applying protective barriers in conjunction with standard PPE that physicians may have as added protection during intubation.…”

mentioning

confidence: 99%

Comparison of the Effectiveness of Different Barrier Enclosure Techniques in Protection of Healthcare Workers During Tracheal Intubation and Extubation

et al. 2020

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The coronavirus disease 2019 (COVID-19; SARS-CoV-2) pandemic has created serious challenges to anesthesiologists. As hospitalized patients' respiratory function deteriorates, many will require endotracheal intubation. Airway management of infected patients risks aerosolization of viral-loaded droplets that pose serious hazards to the anesthesiologist and all health care personnel present. The addition of an enclosure barrier during airway management minimizes the hazard by entrapping the droplets and possibly the aerosols within an enclosed space adding additional protection for health care workers. The aim of this study was to compare the effectiveness of different barrier enclosure techniques during tracheal intubation and extubation.

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“…Barrier enclosure was initially intended for intubations during the management of COVID-19 cases/suspects but eventually its use was extended to other specialties like surgery. 9 But, once intubation is over with its use has not been further studies.…”

Section: Discussionmentioning

confidence: 99%

Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak

Kumar

Chaudhry

Lalwani

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Aim To develop a device that can reduce the exposure of aerosols to healthcare workers (HCWs) who are working in coronavirus disease-2019 (COVID-19) critical units. Background Barrier enclosure has recently been proposed for use during intubations where the risk of aerosolization is high. In COVID-19 outbreak, use of noninvasive respiratory support is increasing. But at the same time, it is associated with high risk of aerosol generation, leading to infections among HCWs. We have made a modification in the intubation box and hence expanded its use with an aim to reduce COVID-19 exposure. Technique Vacuum suction tubing was attached to wall mount, and the other end of tubing was fixed, using adhesive surgical tapes, to the inside of the roof of barrier enclosure. Keeping the vacuum suction switched-on inside the box created a negative pressure while overall air flow is into the box from outside. This led us to believe that aerosols if generated are not contaminating patient's vicinity. Currently, we are using barrier enclosure boxes on all patients who are on noninvasive support (noninvasive ventilation or high-flow oxygen therapy). Conclusion and clinical significance We believe that adding barrier enclosure with the above-mentioned negative-pressure modification will provide an opportunity to use noninvasive support widely, while at the same time, HCW's exposure to aerosols will be reduced. How to cite this article Kumar P, Chaudhry D, Lalwani LK, Singh PK. Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak. Indian J Crit Care Med 2020;24(9):835–837.

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Additional Barrier to Protect Health Care Workers During Intubation

Cited by 9 publications

References 1 publication

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

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

Comparison of the Effectiveness of Different Barrier Enclosure Techniques in Protection of Healthcare Workers During Tracheal Intubation and Extubation

Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak

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