Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; 24-hour Outpatient and Emergency Department, Gleneagles Hospital Hong Kong, Hong Kong Special Administrative Region, China.
Department of Anaesthesiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Anaesthesiology/Critical Care Unit, Gleneagles Hospital Hong Kong, Hong Kong Special Administrative Region, China.
J Emerg Med. 2021 Dec;61(6):695-704. doi: 10.1016/j.jemermed.2021.07.023. Epub 2021 Sep 9.
The aerosol box and intubation tent are improvised barrier-enclosure devices developed during the novel coronavirus pandemic to protect health care workers from aerosol transmission.
Using time to intubation as a crude proxy, we aimed to compare the efficiency and usability of the aerosol box and intubation tent in a simulated manikin.
This was a single-center, randomized, crossover manikin study involving 28 participants (9 anesthetists, 16 emergency physicians, and 3 intensivists). Each participant performed rapid sequence intubations in a random sequence of three different scenarios: 1) no device use; 2) aerosol box; 3) intubation tent. We compared the time to intubation between different scenarios.
The median total intubation time with no device use, aerosol box, and intubation tent were 23.7 s (interquartile range [IQR] 19.4-28.4 s), 30.9 s (IQR 24.1-52.5 s), and 26.0 s (IQR 22.1-30.8 s), respectively. Post hoc analysis showed a significantly longer intubation time using the aerosol box compared with no device use (p < 0.001) and compared with the intubation tent (p < 0.001). The difference between the intubation tent and no device use was not significant. The first-pass intubation success rate did not differ between the groups. Only aerosol box use had resulted in breaches of personal protective equipment. Participants considered intubation with the intubation tent more favorable than the aerosol box.
The intubation tent seems to have a better barrier-enclosure design than the aerosol box, with a reasonable balance between efficiency and usability. Further evaluation of its efficacy in preventing aerosol dispersal and in human studies are warranted prior to recommendation of widespread adoption.
气溶胶盒和插管帐篷是在新冠疫情期间开发的临时防护隔离设备，用于保护医护人员免受气溶胶传播。
以插管时间为粗略替代指标，我们旨在模拟人体模型中比较气溶胶盒和插管帐篷的效率和可用性。
这是一项单中心、随机、交叉模拟人体模型研究，涉及 28 名参与者（9 名麻醉师、16 名急诊医生和 3 名重症监护医生）。每个参与者在三种不同场景下按随机顺序进行快速序贯插管：1）不使用设备；2）气溶胶盒；3）插管帐篷。我们比较了不同场景下的插管时间。
不使用设备、气溶胶盒和插管帐篷时的总插管时间中位数分别为 23.7 秒（四分位距 [IQR] 19.4-28.4 秒）、30.9 秒（IQR 24.1-52.5 秒）和 26.0 秒（IQR 22.1-30.8 秒）。事后分析显示，使用气溶胶盒时的插管时间明显长于不使用设备（p < 0.001）和插管帐篷（p < 0.001）。插管帐篷和不使用设备之间的差异不显著。各组的首次插管成功率无差异。只有气溶胶盒的使用导致了个人防护设备的破损。参与者认为插管帐篷比气溶胶盒更有利。
与气溶胶盒相比，插管帐篷的防护隔离设计似乎更好，在效率和可用性之间取得了合理的平衡。在推荐广泛采用之前，需要进一步评估其在防止气溶胶扩散方面的疗效和在人体研究中的应用。
