Protective Device during Airway Management in Patients with Coronavirus Disease 2019 (COVID-19)

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

“… Not specified tests (qualitative assessment of clearance of fluorescein tracer, and contamination of the operator, bag, table, and support structures) Barrier-enclosure system for intubation During a simulated airway management training session of our COVID-19 intubation team, direct vision, communication, and manoeuvrability were accomplished for 12 operators. Fonseca and colleagues 6 Correspondence Technical description Anti-Aerosol Igloo (polyethylene terephthalate + CPS) N/A Simulation; case series (not described) Description of the enclosure barrier Seamless, single-piece element shaped like an igloo; easy to clean; lightweight; given the shape, minimal aerosol escape Rahmoune and colleagues 7 Correspondence Clinical report Recycled neonatal incubator hood N/A Unspecified tests on patients in OT/ICU Application of recycled neonatal incubator hood for airway management Intubation feasible, robust, economic; disadvantage: weight, some movements relatively limited Lai and Chang 8 Correspondence Clinical report Carton AB + plastic wrap N/A N/A Application of carton/plastic AB for airway management Economic; limited visibility; patient's discomfort Au Yong and Chen 9 Correspondence Experimental report Plastic tent/screen N/A Human volunteer simulations Application of plastic tent/screen for intubation and extubation Low cost, easy availability, and disposability; room for VLS and bougie Lim and colleagues 10 Correspondence in response to research letter Commentary Plastic tent/screen N/A N/A Application of plastic tent/screen for intubation and extubation Concerns for claustrophobia, secondary aerosolisation, impingement of airway devices Yang and colleagues 11 Correspondence Simulation study AB N/A (single test?) Comparison of tracheal intubation with direct laryngoscopy, VLS, and VLS + acrylic AB; measurement of trajectory and amount of droplet spread (atomiser model) in airway mannequin (detection system not detailed) Effect of AB on trajectory and am...…”

“…6,15,42e44,54 The most common barrier-enclosure types were plastic wraps or tents (25 reports), 5,9,12,15,17,23e29,31,33,34,38,39,41,42,44,46,47,52,54,56 acrylic aerosol boxes (19 reports), 4e6,8,11,15,16,18,19,22,24,35,36,43,45,51,53,57,58 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, 7 carton box, 8 acrylic panels, 50 surgical retractors, frames and anaesthetic poles, 21,42,44,48 external fixators, 14 suspension laryngoscopy support, 41,55 and modified packaging tray 40 ). In 10 cases, a smoke evacuator/aspirator was reported.…”

“…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. 41,43,52,56 In 24 reports, there was either no setting described or there was a barrier-enclosure description without demonstration.…”

“…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.…”

“… 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, 7 carton box, 8 ac...…”