The impact of a barrier enclosure on time to tracheal intubation: a randomized controlled trial

Abstract

Purpose Novel devices such as the barrier enclosure were developed in hopes of improving provider safety by limiting SARS-CoV-2 transmission during tracheal intubation. Nevertheless, concerns arose regarding a lack of rigorous efficacy and safety data for these devices. We conducted a randomized controlled trial to evaluate the impact of the barrier enclosure on time to tracheal intubation. Method After Research Ethics Board approval, elective surgical patients with normal airway predictors were randomly allocated 1:1 to tracheal intubation with or without a barrier enclosure. The primary outcome was time to tracheal intubation. Secondary outcomes included first-pass success rate, total time of airway manipulation, anesthesiologists’ perception of intubation difficulty, likelihood of use in SARS-CoV-2-positive patients, and patients’ perception of comfort and acceptability. Results There were 48 participants in the barrier enclosure group and 46 participants in the control group. The mean (standard deviation [SD]) time to tracheal intubation was 62 (29) sec with barrier closure and 53 (27) sec without barrier enclosure (mean difference, 9 sec; 95% confidence interval, − 3 to 20; P = 0.14). Anesthesiologists rated the difficulty of intubation higher with barrier enclosure (mean [SD] visual analogue scale score, 27 [26] mm vs 9 [17] mm; P < 0.001). There were no significant differences in other secondary outcomes. Conclusion In healthy surgical patients with normal airway predictors, the use of a barrier enclosure during tracheal intubation did not significantly prolong time to intubation or decrease first-pass intubation success. Nevertheless, there was an increase in difficulty of intubation perceived by the anesthesiologists with use of a barrier enclosure. Trial registration www.clinicaltrials.gov (NCT04366141); registered 28 April 2020. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02024-z.

Sheet Barrier and Intubating Stylet

“…Based on what has been observed and reported in the literature, a large criticism of rigid box systems has been a delay in time to intubation, with potential worsening of airway views especially in difficult intubation situations [43][44][45]. The rigid plastic structure limits the maneuvers an airway manager might perform to optimize the glottic view (Figures 2A and 8), and it might also hinder other staff from providing assistance during the intubation attempts.…”

Manejo de la vía área en paciente covid 19

“…Es así que, los autores de los estudios Madabhushi et al 4 y Tim T. H. Jen et al 11 realizaron estudios en similares condiciones pero esta vez en pacientes reales en cirugías programadas y con vía aérea normal, donde se corroboro que el uso de la caja de aerosoles en ambientes controlados y de relativa facilidad no prolonga en gran medida los tiempos, no aumenta el número de intentos y los errores en la intubación. Los tiempos de inducción fueron comparables (65,9 segundos vs 67,7) en el primer estudio y diferencia media de 9 segundos; 95% intervalo de confianza, P = 0,14 no significativa con tiempos ligeramente mayores para la caja de aerosoles (53 segundos vs 62) en el segundo estudio.…”

Influence of additional personal protective equipment on team performance in simulation-based emergency scenarios: a randomised controlled trial

“…Examples of additional protective measures include hooded coveralls, shoe covers, double eye protection (goggles and face shield worn at the same time), or the use of more than one pair of gloves. This practice, termed super-safe setting PPE (SSS-PPE), penetrated local policies and hospital guidelines despite evidence suggesting that it can increase physical load and impair tactile sensitivity and manual dexterity 1 , 5 , 6 and no evidence that it brings additional protection. 7 We therefore hypothesised that SSS-PPE is inferior to WHO-PPE in terms of medical personnel and team performance during emergencies and impairs patient-centred outcomes.…”