Abolkheir Abdullah B, El-Kabbani Ahmed, Al Raffa Abdullah, AlFattani Areej, Norris Andrew
Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Department of Epidemiology and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Saudi J Anaesth. 2021 Oct-Dec;15(4):396-402. doi: 10.4103/sja.sja_274_21. Epub 2021 Sep 2.
COVID-19 was declared a pandemic by the WHO in 2020. In light of the global shortage of PPE and concerns regarding the safety of healthcare providers, clinicians have resorted to the use of novel protective barriers, such as aerosol boxes and plastic sheets, during aerosol generating procedures, especially tracheal intubation. We compared the effect of these barriers on the tracheal intubation of simulated patients with severe COVID-19 in a crossover study. The study was approved by the Ethics Committee of King Faisal Specialist Hospital, and the procedures were compliant with the COVID-19 airway management guidelines of the Saudi Anesthesia Society. The time to intubation was our primary outcome. Secondary outcomes included number of optimization maneuvers, number of intubation attempts, time to glottic view and ventilation of the lungs, and damage to PPE. Thirteen consultant anesthetists performed 39 tracheal intubations on a manikin using each of three approaches (aerosol box, plastic sheet, and no-barrier). Data were collected via direct and video observation. The plastic sheet approach demonstrated the highest time to intubation (mean ± StE [95% CI]: 33.3s ± 3.5 [25.8- 40.9]) compared to the aerosol box (22.0s ± 2.5 [16.5 - 27.5], < 0.01) and no-barrier approaches (16.1s ± 1.1 [13.7 - 18.4], < 0.0001). Similarly, the plastic sheet approach had the highest time to glottic view, and ventilation intervals compared to the other two approaches, while the no-barrier approach had the shortest time intervals. There were no failed intubations or damage to the PPE sustained during the use of any of the three approaches. The aerosol box does not impose a significant delay in tracheal intubation using video laryngoscopy, unlike the plastic sheet barrier. Further research on the aerosolization risk is warranted before these protective barriers can be considered as mainstay approaches during aerosol generating procedures.
2020年，世界卫生组织宣布新型冠状病毒肺炎（COVID-19）为大流行病。鉴于全球个人防护装备（PPE）短缺以及对医护人员安全的担忧，临床医生在实施产生气溶胶的操作（尤其是气管插管）时，已开始使用新型防护屏障，如气溶胶箱和塑料布。在一项交叉研究中，我们比较了这些屏障对模拟重症COVID-19患者气管插管的影响。该研究获得了法赫德国王专科医院伦理委员会的批准，且操作符合沙特麻醉学会的COVID-19气道管理指南。插管时间是我们的主要观察指标。次要观察指标包括优化操作次数、插管尝试次数、声门暴露时间和肺通气时间，以及个人防护装备的损坏情况。13名麻醉科顾问医生使用三种方法（气溶胶箱、塑料布和无屏障）中的每一种，在人体模型上进行了39次气管插管。数据通过直接观察和视频观察收集。与气溶胶箱（22.0秒±2.5[16.5 - 27.5]，P<0.01）和无屏障方法（16.1秒±1.1[13.7 - 18.4]，P<0.0001）相比，塑料布方法的插管时间最长（平均±标准误[95%置信区间]：33.3秒±3.5[25.8 - 40.9]）。同样，与其他两种方法相比，塑料布方法的声门暴露时间和通气间隔时间最长，而无屏障方法的时间间隔最短。在使用这三种方法中的任何一种过程中，均未出现插管失败或个人防护装备损坏的情况。与塑料布屏障不同，气溶胶箱在使用视频喉镜进行气管插管时不会造成显著延迟。在这些防护屏障被视为产生气溶胶操作期间的主要方法之前，有必要对气溶胶化风险进行进一步研究。
