Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.
West J Emerg Med. 2020 Sep 24;21(6):78-82. doi: 10.5811/westjem.2020.8.48901.
The use of transparent plastic aerosol boxes as protective barriers during endotracheal intubation has been advocated during the severe acute respiratory syndrome coronavirus 2 pandemic. There is evidence of worldwide distribution of such devices, but some experts have warned of possible negative impacts of their use. The objective of this study was to measure the effect of an aerosol box on intubation performance across a variety of simulated difficult airway scenarios in the emergency department.
This was a randomized, crossover design study. Participants were randomized to intubate one of five airway scenarios with and without an aerosol box in place, with randomization of intubation sequence. The primary outcome was time to intubation. Secondary outcomes included number of intubation attempts, Cormack-Lehane view, percent of glottic opening, and resident physician perception of intubation difficulty.
Forty-eight residents performed 96 intubations. Time to intubation was significantly longer with box use than without (mean 17 seconds [range 6-68 seconds] vs mean 10 seconds [range 5-40 seconds], p <0.001). Participants perceived intubation as being significantly more difficult with the aerosol box. There were no significant differences in the number of attempts or quality of view obtained.
Use of an aerosol box during difficult endotracheal intubation increases the time to intubation and perceived difficulty across a range of simulated ED patients.
在 2019 年冠状病毒病大流行期间，提倡在气管插管期间使用透明塑料气溶胶盒作为保护屏障。有证据表明这些设备在全球范围内都有分布，但一些专家警告说，它们的使用可能会产生负面影响。本研究的目的是测量在急诊科各种模拟困难气道情况下，气溶胶盒对插管性能的影响。
这是一项随机、交叉设计的研究。参与者被随机分为五组气道场景，一组在有气溶胶盒的情况下进行插管，一组在没有气溶胶盒的情况下进行插管，插管顺序随机。主要结局是插管时间。次要结局包括插管尝试次数、Cormack-Lehane 视图、声门开口百分比以及住院医师对插管难度的感知。
48 名住院医师进行了 96 次插管。使用盒子的插管时间明显长于不使用盒子的时间（使用盒子的平均时间为 17 秒[范围为 6-68 秒]，不使用盒子的平均时间为 10 秒[范围为 5-40 秒]，p<0.001）。参与者认为使用气溶胶盒使插管明显更加困难。尝试次数或获得的视图质量没有显著差异。
在困难的气管插管过程中使用气溶胶盒会增加插管时间和感知难度，涉及一系列模拟 ED 患者。
