Intensive Care Unit, Cabrini Hospital, Malvern, Vic, Australia.
2nd General Health Battalion, Australian Army, Brisbane, QLD, Australia.
Anaesthesia. 2020 Aug;75(8):1014-1021. doi: 10.1111/anae.15115. Epub 2020 Jun 1.
The coronavirus disease 2019 pandemic has led to the manufacturing of novel devices to protect clinicians from the risk of transmission, including the aerosol box for use during tracheal intubation. We evaluated the impact of two aerosol boxes (an early-generation box and a latest-generation box) on intubations in patients with severe coronavirus disease 2019 with an in-situ simulation crossover study. The simulated process complied with the Safe Airway Society coronavirus disease 2019 airway management guidelines. The primary outcome was intubation time; secondary outcomes included first-pass success and breaches to personal protective equipment. All intubations were performed by specialist (consultant) anaesthetists and video recorded. Twelve anaesthetists performed 36 intubations. Intubation time with no aerosol box was significantly shorter than with the early-generation box (median (IQR [range]) 42.9 (32.9-46.9 [30.9-57.6])s vs. 82.1 (45.1-98.3 [30.8-180.0])s p = 0.002) and the latest-generation box (52.4 (43.1-70.3 [35.7-169.2])s, p = 0.008). No intubations without a box took more than 1 min, whereas 14 (58%) intubations with a box took over 1 min and 4 (17%) took over 2 min (including one failure). Without an aerosol box, all anaesthetists obtained first-pass success. With the early-generation and latest-generation boxes, 9 (75%) and 10 (83%) participants obtained first-pass success, respectively. One breach of personal protective equipment occurred using the early-generation box and seven breaches occurred using the latest-generation box. Aerosol boxes may increase intubation times and therefore expose patients to the risk of hypoxia. They may cause damage to conventional personal protective equipment and therefore place clinicians at risk of infection. Further research is required before these devices can be considered safe for clinical use.
新型冠状病毒 2019 疫情促使研发出新型设备以保护临床医生免受传播风险，包括在气管插管期间使用的气溶胶盒。我们采用现场模拟交叉研究，评估了两种气溶胶盒（早期一代盒和最新一代盒）对严重新型冠状病毒 2019 患者插管的影响。模拟过程遵循安全气道协会新型冠状病毒 2019 气道管理指南。主要结局为插管时间；次要结局包括一次通过成功率和个人防护设备的突破。所有插管均由专科（顾问）麻醉师进行，并进行视频记录。12 名麻醉师进行了 36 次插管。无气溶胶盒的插管时间明显短于早期一代盒（中位数（IQR [范围]）42.9（32.9-46.9 [30.9-57.6]s 比 82.1（45.1-98.3 [30.8-180.0]s，p=0.002）和最新一代盒（52.4（43.1-70.3 [35.7-169.2]s，p=0.008）。无盒插管无一例超过 1 分钟，而有盒插管 14 例（58%）超过 1 分钟，4 例（17%）超过 2 分钟（包括 1 例失败）。无盒时所有麻醉师均获得一次通过成功率。使用早期一代盒和最新一代盒时，分别有 9 名（75%）和 10 名（83%）参与者获得一次通过成功率。使用早期一代盒发生 1 次个人防护设备突破，使用最新一代盒发生 7 次突破。气溶胶盒可能会增加插管时间，从而使患者面临缺氧的风险。它们可能会损坏常规个人防护设备，从而使临床医生面临感染风险。在这些设备可被认为安全用于临床使用之前，需要进一步研究。
