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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Anaesthesia
2020 ; 75
(8
): 1014-1021
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The aerosol box for intubation in coronavirus disease 2019 patients: an in-situ
simulation crossover study
#MMPMID32397008
Begley JL
; Lavery KE
; Nickson CP
; Brewster DJ
Anaesthesia
2020[Aug]; 75
(8
): 1014-1021
PMID32397008
show ga
The coronavirus disease 2019 pandemic has led to the manufacturing of novel
devices to protect clinicians from the risk of transmission, including the
aerosol box for use during tracheal intubation. We evaluated the impact of two
aerosol boxes (an early-generation box and a latest-generation box) on
intubations in patients with severe coronavirus disease 2019 with an in-situ
simulation crossover study. The simulated process complied with the Safe Airway
Society coronavirus disease 2019 airway management guidelines. The primary
outcome was intubation time; secondary outcomes included first-pass success and
breaches to personal protective equipment. All intubations were performed by
specialist (consultant) anaesthetists and video recorded. Twelve anaesthetists
performed 36 intubations. Intubation time with no aerosol box was significantly
shorter than with the early-generation box (median (IQR [range]) 42.9 (32.9-46.9
[30.9-57.6])s vs. 82.1 (45.1-98.3 [30.8-180.0])s p = 0.002) and the
latest-generation box (52.4 (43.1-70.3 [35.7-169.2])s, p = 0.008). No intubations
without a box took more than 1 min, whereas 14 (58%) intubations with a box took
over 1 min and 4 (17%) took over 2 min (including one failure). Without an
aerosol box, all anaesthetists obtained first-pass success. With the
early-generation and latest-generation boxes, 9 (75%) and 10 (83%) participants
obtained first-pass success, respectively. One breach of personal protective
equipment occurred using the early-generation box and seven breaches occurred
using the latest-generation box. Aerosol boxes may increase intubation times and
therefore expose patients to the risk of hypoxia. They may cause damage to
conventional personal protective equipment and therefore place clinicians at risk
of infection. Further research is required before these devices can be considered
safe for clinical use.