Comparison of three tracheal intubation methods for reducing droplet spread for use in COVID-19 patients

Yang, Stephen Su; Zhang, Michelle; Chong, Jaron

doi:10.1016/j.bja.2020.04.083

Cited by 20 publications

(24 citation statements)

References 5 publications

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“…Subsequently, this strategy was validated on four sheep in 2008 for 12 h, and on two awake humans for 10 min. 6,7 However, prolonged support of multiple patients per ventilator is challenging because of the inability to compensate for variability in patient size and pulmonary compliance, which can also vary over the course of the disease. 8 COVID-19 patients typically require 10 days of mechanical ventilatory support, and the inability to individualise tidal volume during this time could lead to hyper-or hypoventilation.…”

mentioning

confidence: 99%

Use of a high-flow extractor to reduce aerosol exposure in tracheal intubation

Matava

Collard

Siegel

et al. 2020

British Journal of Anaesthesia

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ventilation grills to filter the air passing to recovery was the best solution for our case. We designed a housing for the filters to ensure a good seal. After installation, theatre ventilation function testing was repeated. In view of the increased resistance to air flow created by the filter, we assessed for a potential air leak, which was found to be significant. The smoke seal on the theatre doors was refitted. Further testing showed that the theatre air changes remained above the recommended minimum 25 per hour with negligible leak and contamination of adjacent areas. It is important to highlight that in a modified airborne infection isolation room such as this, the mechanical elements degenerate over time, rendering them inefficient and placing staff and patients at risk. They therefore require regular testing and maintenance to ensure they are operating effectively, the frequency of which should be guided by the manufacturer. Usual precautions required in respiratory isolation, such as keeping doors closed and using appropriate protective equipment, must also be adhered to. As our obstetric theatre setup is not unusual, we considered that we may not be alone in facing this infection control challenge. With the COVID-19 crisis potentially continuing for some time, we wished to share our experience in the hope that this will prove useful to colleagues in other hospitals and trusts.

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mentioning

confidence: 99%

Use of a high-flow extractor to reduce aerosol exposure in tracheal intubation

Matava

Collard

Siegel

et al. 2020

British Journal of Anaesthesia

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“…When evaluating a novel device, such as the aerosol box, the learning effect should be considered. The use of the aerosol box is highly controversial [12][13][14][15][16][17][18][19][20][21][22]. We believe that the current simulation study results would be referred for the safe use of aerosol boxes in clinical practice.…”

Section: Discussionmentioning

confidence: 88%

“…We enrolled 37 personnel (11 women and 26 men) with 12 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] years of anesthesia and intensive care experience; all their records were incorporated into the nal analysis (Figure 1). (P=0.247).…”

Section: Resultsmentioning

confidence: 99%

“…Our results are not applicable to situations such as di cult airways and emergency airway settings. In such situations, the box should be removed and the airway secured in the best possible manner [11,12,17].…”

Section: Discussionmentioning

confidence: 99%

“…The "aerosol box" was rst conceived by a Taiwanese doctor and was reported effective in preventing widespread dispersion of cough droplets during tracheal intubation [10][11][12]. This box was also expected to be useful in situations where higher-level personal protective equipment (PPE), such as the medical protective head hood and powered air-purifying respirators is unavailable [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Macintosh laryngoscope, i-view™, and C-MAC® video laryngoscopes for tracheal intubation with an aerosol box: A randomized, crossover, manikin study

Nakanishi

Sento

Kamimura

et al. 2020

Preprint

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Background: The aerosol box was designed to prevent cough droplets from spreading, but it can impede tracheal intubation. We tested the hypothesis that the C-MAC® video laryngoscope (C-MAC) with an external display is more useful than the i-view™ video laryngoscope (i-view) with an integrated display, or a Macintosh direct laryngoscope (Macintosh) for tracheal intubation with an aerosol box.Methods: This prospective, randomized, crossover simulation study was conducted at an operating room of the two hospitals (a university hospital and a tertiary teaching hospital). We recruited 37 medical personnel (36 anesthesiologists and 1 dental anesthesiologist) who were working in the fields of anesthesia and intensive care with > 2 years of dedicated anesthesia experience from five hospitals. We divided the participants into six groups to use the laryngoscope in a determined order. After the training using each laryngoscope without a box, the participants performed tracheal intubation thrice with each laryngoscope with at least two-hour intervals. The primary outcome was the intubation time. The secondary outcomes were the success rate, Cormack-Lehane grade, and subjective difficulty scale score (numeric rating scale 0–10, 0: no difficulty, 10: highest difficulty). We used the Friedman test and the Wilcoxon signed-rank test with Bonferroni adjustment. Data are shown as median [interquartile range].Results: Thirty-seven personnel (11 women and 26 men) with 12 [5–19] (median [interquartile range]) years of anesthesia and intensive care experience were enrolled. There was no significant difference in the intubation time: 30 [26–32] s for Macintosh, 29 [26–32] s for i-view, and 29 [25–31] s for C-MAC (P=0.247). The success rate was 95%–100% without significant difference (P=0.135). The i-view and C-MAC video laryngoscopes exhibited superior Cormack-Lehane grades and lower subjective difficulty scale scores than the Macintosh laryngoscope; however, there were no differences between the i-view and C-MAC video laryngoscopes.Conclusions: Rapid and highly successful tracheal intubation was possible with Macintosh laryngoscope, i-view, and C-MAC video laryngoscopes on a manikin with an aerosol box. Improved Cormack-Lehane grade and ease of procedure may support the use of video laryngoscopes.Trial registration: UMIN Clinical Trials Registry, identifier UMIN000040269.

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