Comparison of the Characteristics of Intubation Airway Barrier Devices Using a Simulated Airway Task Trainer

Abstract

Background: With the advent of variant strains such as Delta and Omicron, there have been renewed concerns regarding transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease 2019 (COVID-19)) disease to healthcare professionals, particularly during intubation procedures. Several forms of barrier protection aimed at decreasing the spread of aerosolized droplets were developed during the early onset of the pandemic.Objectives: Using a simulated airway model, we examined the impact that three separate barrier devices had on intubation time and success using both direct and video laryngoscopy. We hypothesized that the functionally simplistic devices would be preferred and would allow for faster intubations.Methods: Just-in-time training sessions focusing on COVID-19 intubations were set up between March and June of 2020. Sixty-seven emergency physicians and anesthesiologists participated. For a subset of physicians, exact times to barrier device setup and both direct and indirect intubations using three different barrier devices were recorded. Subsequently, physicians were asked to fill out a survey regarding their experiences.Results: The survey response rate was 60%. In general, this cohort preferred a plain clear plastic drape or clear plastic drape with polyvinyl chloride (PVC) cube for direct laryngoscopy and video laryngoscopy setups. The use of these two devices resulted in significantly faster times to completed intubation when compared with the fiberglass box while using a simulated task trainer. Conclusion:In general, a simple, plastic sheet was the preferred barrier device using video laryngoscopy. Although setup times were faster using the fiberglass box, intubation times were significantly faster using the plastic drape or PVC frame.

Video-Assisted Stylet Intubation with a Plastic Sheet Barrier, a Safe and Simple Technique for Tracheal Intubation of COVID-19 Patients

“…In this paper, we describe a simple method using the Shikani technique and an inexpensive and readily available clear plastic drape which covers the patient’s head and upper body and contains any aerosol spread during airway intubation [ 9 , 10 , 11 , 12 ]. Devices incorporating the use of a plastic drape and/or barrier were previously reported for provider protection during airway management and aerosol-generating medical procedures (AGMPs) [ 13 ]. Using the Shikani video-assisted intubating stylet through the drape allows the operator to continuously visualize the upper airway and glottis from a distance during the intubation without the operator having to place his/her face close to the mouth of the patient.…”

“…We proposed applying a piece of clear plastic sheet as a drape along with a video-assisted intubating stylet for tracheal intubation to protect the intubator from exposure to the aerosol and/or secretions during intubation ( Figure 2 and Figure 3 ) [ 9 , 10 , 11 , 12 ]. The clear and soft plastic sheet adds an additional layer of protection against the possible splash of secretion/mucus, without interference or hindering of the intubation procedure [ 13 ]. In this report, we share our own clinical experience of applying the Shikani video-assisted intubating stylet technique [ 14 , 15 , 16 , 17 ] with a plastic sheet that acts as an ancillary barrier in patients during the Omicron pandemic in Taiwan ( Figure 1 , time point B).…”