Department of Emergency Medicine, Anaesthesia and Intensive Care, Policlinico Vittorio Emanuele San Marco University Hospital, Catania, Italy.
Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA.
Br J Anaesth. 2020 Dec;125(6):880-894. doi: 10.1016/j.bja.2020.08.038. Epub 2020 Sep 3.
Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fifty-two articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.
医护人员暴露于严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）是在 2019 年冠状病毒病（COVID-19）大流行期间的一个重大安全问题，需要接触/飞沫/空气传播预防措施。由于全球短缺，个人防护设备（PPE）的有限可用性促使开发了屏障封闭系统，例如气溶胶盒、塑料帷幕和类似的防护系统。我们检查了有关疑似/确诊 COVID-19 患者气道管理的屏障封闭系统的现有证据和科学出版物。使用德尔菲法和改良的名义小组技术，对 MEDLINE/Embase/Google Scholar 数据库（从 2019 年 12 月 1 日至 2020 年 5 月 27 日）中所有关于 COVID-19 气道管理的屏障封闭系统的文章进行了搜索，包括参考文献和网站。由一个专家组对所有来源进行了审查。对 52 篇文章进行了回顾，以评估其关于屏障设备可行性、优点、对飞沫和气溶胶的保护、有效性、安全性、人体工程学以及清洁/处置的结果和证据水平。分析的大多数论文是专家意见、小型病例系列、技术说明、小样本模拟研究和预印本证明。屏障封闭设备的使用增加了气道程序的复杂性，并可能产生不良后果，尤其是在气道紧急情况下。关注的问题包括限制进行气道干预的能力和助手可以提供的帮助、患者受伤、PPE 完整性受损、缺乏对医护人员的额外保护的证据（包括屏障移除后二次气溶胶化）以及缺乏清洁标准。气道管理的封闭屏障不能替代足够的 PPE，在能够报告充分验证研究之前，应避免使用。
