Patient barrier acceptance during airway management among anesthesiologists: a simulation pilot study

Abstract

Background: Protection of healthcare providers (HCP) has been a serious challenge in the management of patients during the coronavirus 2019 (COVID-19) pandemic. Additional physical barriers have been created to enhance personal protective equipment (PPE). In this study, user acceptability of two novel barriers was evaluated and the performance of airway management using PPE alone versus PPE plus the additional barrier were compared. Methods: An open-label, double-armed simulation pilot study was conducted. Each participant performed bag-mask ventilation and endotracheal intubation using a GlideScope in two scenarios: 1) PPE donned, followed by 2) PPE donned plus the addition of either the isolation chamber (IC) or aerosol box (AB). Endotracheal intubation using videolaryngoscopy was timed. Participants completed pre- and post-simulation questionnaires.Results: Twenty-nine participants from the Department of Anesthesia were included in the study. Pre- and post-simulation questionnaire responses supported the acceptance of additional barriers. There was no significant difference in intubating times across all groups (PPE vs. IC 95% CI, 26.3–35.1; PPE vs. AB 95% CI, 25.9–35.5; IC vs. AB 95% CI, 23.6–39.1). Comparison of post-simulation questionnaire responses between IC and AB showed no significant difference. Participants did not find the additional barriers negatively affected communication, visualization, or maneuverability. Conclusions: Overall, the IC and AB were comparable, and there was no negative impact on performance under testing conditions. Our study suggests the positive acceptance of additional patient protection barriers by anesthesia providers during airway management.

Prevenção à exposição por aerossóis da COVID-19 durante a intubação orotraqueal

“…38 When dealing with preventive measures during OTI, studies mostly bring the use of protective barriers in association with the use of PPE: devices in box format, plastic and cover that cover the patients' headboard. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]32,33,35 The hypothesis raised is that only the use of PPE does not adequately protect, requiring the association of protective barriers to ensure safety. 36 Intubation boxes are acrylic boxes containing two where the allocates the arms for access to the airway, and an opening in its lower portion to attach the patients' head.…”

“…19 The application of barriers such as an acrylic box makes it possible to concentrate the aerosols inside and prevent dispersion to the environment during the procedure. 15,22,28 However, there was an increase in intubation time compared to non-use, difficulty in mobilizing the intubator and access to the airway, as well as the risk of error in the first attempt to intubate. 15,16,18,19,21,25 In emergencies, the delay and difficulty of access to intubate inadvertently expose patients to hypoxemia and worsening of their clinical condition.…”

A novel protective barrier for extremity surgeries during the COVID-19 pandemic

“…These decreasing levels were statistically significant for each group (p<0.001). [2,[4][5][6][10][11][12][13][14]19,22,25,26]. Thus, it is very important to protect HCWs to maintain the smooth running of healthcare services [2,4,5,8,10,25] and the use of PPE to reduce aerosol contamination is recommended [4][5][6][7][10][11][12][13][14][15]22,[25][26][27].…”

“…spreading particulates [4,[10][11][12][13][14][15][16]. However, this is a challenge when performing invasive and surgical treatments.…”

“…During the pandemic, plastic surgeons, otolaryngologists, maxillofacial surgeons, and anesthesiologists have been performing emergency and time-sensitive invasive and surgical aerosol-generating procedures (AGPs) that are highly susceptible to the transmission of SARS-CoV-2 from the head and neck areas [5,6,[12][13][14][15][16][17][18][19][20]. Therefore, various protective equipment and barriers have been introduced for head and neck surgeries and tracheal intubations [5,6,[10][11][12][13][14][15][16][17][18][21][22][23]. Plastic, orthopedic and hand surgeons have also performed many emergency surgical interventions on the extremities, especially those of the hands, during the pandemic.…”