Systematic Review of Simulated Airway Management Whilst Wearing Personal Protective Equipment

Abstract

therapy using portable, single-use systems has been increasingly used following cesarean delivery, larger studies are needed to evaluate its ability to decrease infections. This study aimed to compare the effects of prophylactic negative pressure wound therapy and standard wound dressing on risk of surgical-site infections. The authors hypothesized negative pressure wound therapy would decrease infections.This open-label trial was conducted at 4 academic medical centers in the United States. Patients were recruited between February 8, 2017 and November 13, 2019. Eligibility criteria included body mass index (BMI) of 30 or more (measured pre-pregnancy or at first antenatal visit), and delivery via cesarean at 23 weeks' gestation or later. Patients were excluded if they were not available for follow-up, had a contraindication to negative pressure use, had a bleeding disorder, on therapeutic anticoagulation, or had an allergy to silicone or adhesive tape. Patients were randomized to prophylactic negative pressure wound therapy or standard wound dressing. Standard infection prevention protocol, including pre-incision antibiotics, skin preparation, closure of the subcutaneous layer (if depth of 2 cm or greater), and skin closure with subcutaneous suture, was provided for all participants. In the standard dressing group, wound dressings consisted of layers of gauze and adhesive tape that were removed after 24 hours. For the negative pressure group, the Prevena negative pressure device (which delivers −125 mm Hg negative pressure) was secured using fixation adhesion strips and removed when patients were discharged. Followup was conducted by phone approximately 30 days following delivery. Patients were asked if they had symptoms of surgical-site infection or had visited a physician's office, emergency department or hospital for wound complications. Postoperative medical records were obtained and reviewed for diagnosis of surgical-site infection. Superficial or deep surgical-site infection was the primary outcome. Secondary outcomes included patient pain scores, satisfaction scores at discharge and at follow-up, organ-space infection and other wound complications.