Department of Anaesthesia, Queensland Children's Hospital, Brisbane, Queensland, Australia.
Science and Engineering Faculty, School of Earth & Atmospheric Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
Paediatr Anaesth. 2021 Mar;31(3):323-329. doi: 10.1111/pan.14103. Epub 2020 Dec 23.
Barrier techniques, such as plastic sheets or intubation boxes, are purported to offer additional protection for healthcare workers.
To assess the functionality, perceived safety, droplet protection, and aerosol protection of several barrier techniques.
Firstly, a simulation study with 12 different laryngoscopists was conducted to assess the time taken to perform an intubation (via direct laryngoscopy, via video laryngoscopy, and via a bougie) with four different barrier techniques (personal protective equipment only, a plastic sheet, a tented plastic sheet, and an intubation box). Secondly, a cough at the time of intubation was simulated using ultraviolet dye to assess the spread of droplets; and thirdly, smoke was used to assess the spread of aerosols.
Intubation time using the box was noninferior to using no barrier. Based on subjective ratings by the laryngoscopists, the most functional technique was no barrier followed by the intubation box, then the tented sheet, and then the plastic sheet. The technique that conferred the highest feeling of safety to the laryngoscopists was the intubation box, followed by the tented sheet, then no barrier, and then the plastic sheet. All the barriers prevented the ultraviolet dye contaminating the head and torso of the laryngoscopist. Smoke remained within the intubation box if plastics sheets were used to cover the openings and suction was ineffective at clearing it. With no barrier in place, smoke was effectively cleared away from the patient in a theater with laminar flow but tended to spread up toward the laryngoscopist in a room without laminar flow.
A well-designed intubation box is an effective barrier against droplets and is noninferior to no barrier in relation to intubation time. However, a box interferes with laminar flow in theaters with formal ventilation systems and may result in accumulation of aerosols if it is completely enclosed.
屏障技术，如塑料薄膜或插管盒，据称可为医护人员提供额外的保护。
评估几种屏障技术的功能、感知安全性、飞沫保护和气溶胶保护。
首先，通过 12 名不同的喉镜医师进行模拟研究，评估使用四种不同屏障技术（仅个人防护设备、塑料薄膜、帐篷式塑料薄膜和插管盒）进行气管插管（直接喉镜、视频喉镜和通过探条）的时间。其次，使用紫外线染料模拟插管时的咳嗽，以评估飞沫的扩散；第三，使用烟雾评估气溶胶的扩散。
使用盒进行插管的时间不比不使用屏障长。根据喉镜医师的主观评分，最实用的技术是无屏障，其次是插管盒，然后是帐篷式薄膜，最后是塑料薄膜。对喉镜医师来说，感觉最安全的技术是插管盒，其次是帐篷式薄膜，然后是无屏障，最后是塑料薄膜。所有屏障都防止了紫外线染料污染喉镜医师的头部和躯干。如果使用塑料薄膜覆盖开口，烟雾仍会留在插管盒内，并且抽吸无法有效地清除烟雾。如果没有屏障，烟雾会在层流的剧院中有效地从患者身上清除，但在没有层流的房间中，烟雾往往会向喉镜医师扩散。
设计良好的插管盒是一种有效的飞沫屏障，与不使用屏障相比，插管时间无差异。然而，在具有正式通风系统的剧院中，盒子会干扰层流，如果完全封闭，可能会导致气溶胶积聚。
