Rapid clearing of aerosol in an intubation box by vacuum filtration

Hellman, Samuel; Chen, Grant; Irie, Takeshi

doi:10.1016/j.bja.2020.06.017

Cited by 14 publications

(14 citation statements)

References 6 publications

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“…Two studies (2%, n = 2/83) used a device in pediatric laryngoscopy and bronchoscopy [ 54 , 55 ]. Nine studies (7%) discussed these devices for general AGMPs [ 22 , 25 , 32 , 46 , [56] , [57] , [58] , [59] , [60] ] and 9 (7%) for endoscopic procedures. [ 10 , 11 , 43 , 45 , [61] , [62] , [63] , [64] ]…”

Section: Resultsmentioning

confidence: 99%

Barrier enclosure use during aerosol-generating medical procedures: A scoping review

Price

Ben-Yakov

Choi

et al. 2021

The American Journal of Emergency Medicine

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Introduction Barrier enclosure devices were introduced to protect against infectious disease transmission during aerosol generating medical procedures (AGMP). Recent discussion in the medical community has led to new designs and adoption despite limited evidence. A scoping review was conducted to characterize devices being used and their performance. Methods We conducted a scoping review of formal databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus), grey literature, and hand-searched relevant journals. Forward and reverse citation searching was completed on included articles. Article/full-text screening and data extraction was performed by two independent reviewers. Studies were categorized by publication type, device category, intended medical use, and outcomes (efficacy – ability to contain particles; efficiency – time to complete AGMP; and usability – user experience). Results Searches identified 6489 studies and 123 met criteria for inclusion (k = 0.81 title/abstract, k = 0.77 full-text). Most articles were published in 2020 (98%, n = 120) as letters/commentaries (58%, n = 71). Box systems represented 42% ( n = 52) of systems described, while plastic sheet systems accounted for 54% ( n = 66). The majority were used for airway management (67%, n = 83). Only half of articles described outcome measures (54%, n = 67); 82% ( n = 55) reporting efficacy, 39% ( n = 26) on usability, and 15% ( n = 10) on efficiency. Efficacy of devices in containing aerosols was limited and frequently dependent on use of suction devices. Conclusions While use of various barrier enclosure devices has become widespread during this pandemic, objective data of efficacy, efficiency, and usability is limited. Further controlled studies are required before adoption into routine clinical practice.

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Section: Resultsmentioning

confidence: 99%

Barrier enclosure use during aerosol-generating medical procedures: A scoping review

Price

Ben-Yakov

Choi

et al. 2021

The American Journal of Emergency Medicine

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“…For example, ports have been added to the side of the box so that the assistant can insert his or her hands to remove a stylet after tracheal intubation, or ports added to the top of the box for insertion of a bougie to intubate the trachea [16,20]. Another modifications include a device or system to minimize spread of aerosol from the box, by attaching a plastic drape to the box, to spread the drape over the patient's chest, or by attaching a suction system to the box [22][23][24]. Some also have used transparent drapes, or plastic "balloons" to make an aerosol containment device [23][24][25].…”

Section: Aerosol Containment Devicementioning

confidence: 99%

“…To prevent the problem of viral aerosols to escape out of an aerosol containment device, some have produced a negative air-flow environment by applying suction mechanism [22][23][24][25]. In one report, a large cubic frame was created with polyvinylchloride tubes (60 × 60 × 60 cm), and clear plastic bags (400-800 L capacity) were used to enclose the space [23].…”

Section: Spread Of Aerosolsmentioning

confidence: 99%

“…With this system, no aerosols escaped from the aerosol containment device, and aerosols were successfully suctioned continuous negative airflow through vacuum mechanisms. Placing a highefficiency viral filter (which had 99.9999% viral filtration efficiency) between the suction port and the suction tubing would prevent contamination of the suction system [22].…”

Section: Spread Of Aerosolsmentioning

confidence: 99%

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

Saito

2020

J Anesth

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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.

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“…A possible solution for such procedures would be the use of a protective box. The idea of a protective box first appeared in 2020 [9] and soon, multiple improvements were published [10][11][12][13][14]. The primary idea is to assemble a box-like object around the patient's head and upper torso, which would contain any droplets and aerosols generated by the patient.…”

Section: Introductionmentioning

confidence: 99%

Size- and Time-Dependent Aerosol Removal from a Protective Box during Simulated Intubation and Extubation Procedures

Pirker

Čebašek²,

Serdinšek

et al. 2021

COVID

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Because the SARS-CoV-2 virus primarily spreads through droplets and aerosols, a protective box could provide adequate protection by shielding medical professionals during the intubation and extubation procedures from generated droplets and aerosols. In this study, size- and time-dependent aerosol concentrations were measured inside and outside the protective box in the particle size ranging from 14 nm to 20 μm during simulated intubation and extubation procedures. An improved protective box with active ventilation was designed based on a plastic bag with armholes covered with latex sheets that utilizes a supportive frame. Coughing during the intubation and extubation procedure was simulated using an aerosol generator which dispersed the aerosol powder into the protective box. During the intubation and extubation procedure, the concentration of particles increased inside the protective box but, due to the high negative airflow, quickly dropped to background levels. The particle concentration of all measured particle sizes decreased within the same time frame. No leakage of particles was observed through the armhole openings. The presented protective box design provides excellent protection against generated droplets and aerosols. The decrease in concentration does not depend on the particle size. Outside the box, particle concentration did not change with time.

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Rapid clearing of aerosol in an intubation box by vacuum filtration

Cited by 14 publications

References 6 publications

Barrier enclosure use during aerosol-generating medical procedures: A scoping review

Barrier enclosure use during aerosol-generating medical procedures: A scoping review

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

Size- and Time-Dependent Aerosol Removal from a Protective Box during Simulated Intubation and Extubation Procedures

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