Plastic Screen Versus Aerosol Box as a Barrier During Endotracheal Intubation

Abstract

Background: The severe acute respiratory syndrome coronavirus-2-2019 pandemic has posed significant challenges and barrier devices such as aerosol/intubation box, intubation tent, and intubation screen have been widely used during endotracheal intubation by the clinicians without any definite proven benefit. The initial experience at our institute with the intubation box posed some difficulties leading to failed intubations. Hence, as an alternative, we switched to a transparent plastic intubation screen that is likely to provide better vision and space during intubation. We evaluated the impact of intubation box and plastic screen on intubations in this simulation-based crossover study. Materials and Methods: Ten anesthesiologists performed 90 intubations in an operating room on a Laerdal® adult airway management trainer. Each participant performed 9 intubations, 3 without any barrier and 3 each with intubation box and plastic screen. The primary outcome was intubation time; secondary outcomes included first-pass success and breaches to personal protective equipment. Results: Intubation time with no barrier was significantly shorter than with the intubation box (median interquartile range [IQR]: 25 [22–28] vs. 40 [30–51] s, P < 0.001) and with the screen (median [IQR] 29 [25–35] s, P = 0.015). The intubation time was significantly lesser with the screen compared to the box (P = 0.023). The first-pass success was 86.66%, 96.66%, and 100% in the box, screen, and no barrier groups, respectively. Conclusion: In comparison to an intubation box, the transparent plastic screen decreases intubation times and has greater operator comfort. These devices require further evaluation for patient safety.