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

Abstract

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.

The Role of Healthcare Professionals’ Passion in Predicting Secondary Traumatic Stress and Posttraumatic Growth in the Face of COVID-19: A Longitudinal Approach

“…Similar to this, the differences found between physicians and nurse aides may confirm this tentative explanation, as the higher the lack of resources, the higher the posttraumatic growth, possibly as a way to overcome this initial trauma and the lack of clear procedures [ 38 ]. Interestingly, previous studies have pointed out that being female (as the majority of nurse aides are) and the lack of resources are risk factors for developing STS [ 14 , 53 ], which was confirmed by our findings as well since females presented higher STS. Furthermore, in our case and possibly due to the temporality, the presence of job demands seems to have a huge impact on its developments, prior to sex and job resources.…”

Prevenção à exposição por aerossóis da COVID-19 durante a intubação orotraqueal

“…38 When dealing with preventive measures during OTI, studies mostly bring the use of protective barriers in association with the use of PPE: devices in box format, plastic and cover that cover the patients' headboard. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]32,33,35 The hypothesis raised is that only the use of PPE does not adequately protect, requiring the association of protective barriers to ensure safety. 36 Intubation boxes are acrylic boxes containing two where the allocates the arms for access to the airway, and an opening in its lower portion to attach the patients' head.…”

“…14,20,26,33 Some articles highlighted the need to associate airflows with negative suction systems inside the acrylic box, coupled in HEPA filters, showing less contamination of the intubator, as well as the almost minimal dispersion to the environment. 29,32,35 The post-procedure risk was also evidenced: at the end of intubation, the removal of the acrylic box allows the dispersion of aerosols concentrated inside it directly to the bedside, procedure materials, as well as the team involved. 26,28,30 If the association of barrier protectors with OTI is chosen, teams must be trained in the decontamination of boxes and plastic barriers, with additional risk of exposure during removal after completion of the procedure.…”

Macintosh laryngoscope versus AMBU King Vision video laryngoscope for endotracheal intubation using a COVID-19 barrier box: A randomized controlled trial

“…The position of the endotracheal tube was confirmed by end-tidal carbon dioxide. A COVID-19 barrier box [ Figure 1 ] with negative suction port[ 3 9 ]was used during the entire procedure starting from preoxygenation. It was removed 30 s after confirming the correct positioning of the endotracheal tube.…”