Aerosol box for protection during airway manipulation in covid-19 patients

Vijayaraghavan, Sundeep; Puthenveettil, Nitu

doi:10.4103/ija.ija_375_20

Cited by 9 publications

(6 citation statements)

References 7 publications

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“… 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.…”

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

111

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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%

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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

111

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“…High infectivity of the virus has forced HCWs to produce novel devices such aerosol boxes to protect themselves from getting infected with coronavirus. [ 3 7 ] Anaesthesiologists involved in aerosol-generating procedures like intubation have six times increased risk of acquiring coronavirus infection than other HCWs. [ 8 ] The aerosol box was first described by Dr Lai Hsien-yung.…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ] The aerosol box is nowadays used in conjunction with WHO-recommended safety kits to avoid health workers from getting SARS-CoV-2 infection during aerosol-generating procedures. [ 3 4 ] The use of videolaryngoscopes for intubation results in improved glottic visualisation. [ 5 ] We conducted a study with the hypothesis that video laryngoscopic intubation would be easier than direct laryngoscopy when aerosol box was used.…”

Section: Introductionmentioning

confidence: 99%

Comparison of aerosol box intubation with C-MAC video laryngoscope and direct laryngoscopy—A randomised controlled trial

et al. 2021

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Background and Aims: Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is a highly infectious disease and healthcare workers are at constant risk for contracting it. Nowadays, aerosol box is used in conjunction with WHO-recommended safety kits, to avoid health workers from getting SARS-CoV-2 infection during aerosol-generating procedures. In our study, we compared the ease of oral intubation with C-MAC video laryngoscope and direct laryngoscopy, when the aerosol box was used. The secondary objectives were to compare the incidence of airway loss, haemodynamic changes, number of attempts, and time required for intubation between these two techniques. Methods: This prospective randomised controlled study was conducted on 60 non-coronavirus disease (COVID) patients presenting for elective surgery under general anaesthesia. Patients were randomly assigned into two groups:C and D using a computer-generated random sequence of numbers by closed envelope technique. In group D, laryngoscopy was performed with Macintosh blade and in group C, with Storz® C-MAC video laryngoscope. Results: The ease of intubation was better (grade 1) in group C than D (68.6% vs. 31.4% respectively) with a P value of < 0.001. 10% of patients required more than one intubation attempt in group D compared to none in group C, but this difference was not statistically significant. The intubation time was comparable between the two groups. There were no incidences of loss of airway or failure to intubate in both groups. Conclusion: The use of C-MAC video-laryngoscopy resulted in easier orotracheal intubation as compared to intubation with direct laryngoscopy when the aerosol box was used.

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Barrier enclosure use during aerosol-generating medical procedures: A scoping review

Price

Ben-Yakov

Choi

et al. 2021

The American Journal of Emergency Medicine

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Introduction Barrier enclosure devices were introduced to protect against infectious disease transmission during aerosol generating medical procedures (AGMP). Recent discussion in the medical community has led to new designs and adoption despite limited evidence. A scoping review was conducted to characterize devices being used and their performance. Methods We conducted a scoping review of formal databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus), grey literature, and hand-searched relevant journals. Forward and reverse citation searching was completed on included articles. Article/full-text screening and data extraction was performed by two independent reviewers. Studies were categorized by publication type, device category, intended medical use, and outcomes (efficacy – ability to contain particles; efficiency – time to complete AGMP; and usability – user experience). Results Searches identified 6489 studies and 123 met criteria for inclusion (k = 0.81 title/abstract, k = 0.77 full-text). Most articles were published in 2020 (98%, n = 120) as letters/commentaries (58%, n = 71). Box systems represented 42% ( n = 52) of systems described, while plastic sheet systems accounted for 54% ( n = 66). The majority were used for airway management (67%, n = 83). Only half of articles described outcome measures (54%, n = 67); 82% ( n = 55) reporting efficacy, 39% ( n = 26) on usability, and 15% ( n = 10) on efficiency. Efficacy of devices in containing aerosols was limited and frequently dependent on use of suction devices. Conclusions While use of various barrier enclosure devices has become widespread during this pandemic, objective data of efficacy, efficiency, and usability is limited. Further controlled studies are required before adoption into routine clinical practice.

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Aerosol box for protection during airway manipulation in covid-19 patients

Cited by 9 publications

References 7 publications

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 aerosol box intubation with C-MAC video laryngoscope and direct laryngoscopy—A randomised controlled trial

Barrier enclosure use during aerosol-generating medical procedures: A scoping review

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