The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study

Abstract

The current international COVID-19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air-purifying respirators and powered air-purifying respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq TM ; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered respirator group; however, noise levels were perceived to be significantly lower than in the standard respirator group. We conclude that standard and powered respirators do not significantly prolong simulated advanced intubation procedures.

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

“…45 In contrast, other simulations have shown that the use of powered respirator PPE does not affect the time to intubation and first-pass success of videolaryngoscope-aided tracheal intubation. 73 We must also consider how monitor cables, i.v. tubing, breathing circuits, suction tubing, and bedding might interfere with barrier use and be disrupted by barrier placement and removal.…”

Radiological indicators to predict the application of assistant intubation techniques for patients undergoing cervical surgery

“…Airway management is regarded as the most important aspect in clinical anesthesia and a successful intubation remains crucial for surgical procedures [1]. Clinically, there are many factors associated with difficulty of intubation during laryngoscopy, including head-neck trauma [2], airway abnormalities [3], gastroesophageal reflux disease [4], hard to open mouth [5], impaired cervical mobility [6], etc.…”

Medical Simulation: The Least Advertised and Most Versatile Weapon in Pandemic

“…Many solutions were developed, such as modified full-face snorkel masks for non-invasive ventilation ( 11 ), adapted ventilators to allow ventilation of multiple simultaneous patients ( 12 ), and techniques to help teams move intensive care unit patients to spare human resources, like the use of exoskeletons to help intensive care units with prone positioning ( 13 ). Thanks to simulation centers, these innovations could be designed, tested, and adapted in real-like conditions and in a record time ( 14 ). During crises, simulation centers may act as the rear base of the fight, becoming training camps for care teams and a place for developing strategies.…”