Aerosol containment device for airway management of patients with COVID-19: a narrative review

Abstract

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. To protect healthcare workers from infection during airway management, some expert recommendations and guidelines recommended wearing P2/N95 masks, goggles or glasses, glove, face-shields, and gowns as standard personal protective equipment (PPE). Nevertheless, several simulation studies have suggested that the standard PPE may not fully protect healthcare workers. Dr. Hsien Yung Lai introduced an acrylic box ("aerosol box") as a part of PPE during airway management. Since then, several companies and healthcare workers have made their own modified devices ("aerosol containment device"), and the use of such a device has spread worldwide, without being formally assessed for its effectiveness, efficacy and safety. Several simulation studies have indicated that "aerosol containment device" would make tracheal intubation more difficult. In addition, the device would prevent the spread of droplets from a patient, but may increase the risk of healthcare workers being exposed to a higher concentration of viral aerosols. Therefore, the current state of knowledge indicates that an "aerosol containment device" without vacuum mechanism has only limited efficacy in protecting healthcare workers from viral transmission.

Simulation and evaluation of the protective barrier enclosure for cardiopulmonary resuscitation

“… 15. , 16. Nevertheless, during OHCA, the accessibility of protective barrier enclosure may decrease delivery time of CPR, as it may reduce the hesitation of potential responders.…”

Intubación de pacientes con SARS-CoV-2: una guía «primera línea» para minimizar la generación de aerosoles durante el procedimiento

“…Otro de los componentes de la ventilación con presión positiva es la famosa técnica de «C y E» para ventilación por un reanimador que, ante dificultades técnicas o menor experiencia en su aplicación, incrementa el riesgo de aerosolizar al lado contrario de donde se aplica tal maniobra (Figura 2), obligándonos a cambiar posición, rompiendo el sello en la vía aérea. 7 Derivado de lo previamente descrito, estrategias que tenían como objetivo disminuir la aerosolización, desencadenaron dificultad técnica, mayor exposición así como menor seguridad ante la atención de pacientes. Se describe una modificación que, si bien no es nueva en tema de ventilación para preoxigenación, es novedosa para este tipo de pacientes.…”

Design and in-vitro testing of a portable patient isolation chamber for bedside aerosol containment and filtration

“…The increased in-hospital treatment of COVID-19 has been paired with shortages of hospital personnel, equipment and personal protection equipment, and an increased strain on hospital infrastructure. With COVID-19 showing both airborne and droplet transmission, this has required that the hospital to protect both the healthcare worker and the clinical environment with still attempting to offer a continuum of care [ 2 , 3 ]. In this crisis, many hospitals were forced to delay most elective surgical procedures to focus their efforts on critically ill COVID-19 patients, and reduce the potential transmission of COVID-19 to and by any patients in the healthcare environment [ 4 ].…”