Abstract
To protect clinicians without access to recommended personal protective equipment during aerosol-generating procedures such as endotracheal intubation, various products have been introduced to clinical practice. The authors would like to present a pilot study with a novel intubating box, the LIFE PLUS MINI CAPSULE S®, which has improved systems to prevent the egress of particles from the box as well as a built-in HEPA (High Efficiency Particulate Air) aspiration filter. Nineteen anesthesiologists simulated endotracheal intubation on a mannequin in test conditions with and without using the LIFE PLUS MINI CAPSULE S®. All anesthesiologists successfully intubated the mannequin at first attempt, and there were no failed intubations. The median (range) intubation time was 9.1 (2.0–25.0) seconds longer when the LIFE PLUS MINI CAPSULE S® was used, and there were no breaches of personal protective equipment. The leakage of airborne particles was analyzed using a Qualitative and a Quantitative Fit Test. Although our pilot study shows promising results, further research is required to validate our results in vivo and in a larger sample size which will provide us with a better insight into the efficacy and applicability of this safety tool in emergency and elective clinical conditions.
Highlights
Personal Protective Equipment (PPE) shortages present a tremendous challenge to healthcare systems around the world due to the COVID-19 pandemic
A recent paper published by Turer and colleagues [4] suggested that the use of an intubation box alone may not be sufficient to contain airborne virus particles, a previous study simulating laryngoscopy on a mannequin, which was designed to expel fluorescent dye, showed that this type of barrier greatly reduced the exposure of Health Care Professionals (HCPs) [5]
The LIFE PLUS MINI CAPSULE S® was analyzed for leakage of airborne particles, using a Qualitative Fit Test (QLFT) and a Quantitative Fit Test (QNFT) and was assessed for ease of use during simulated intubation
Summary
Personal Protective Equipment (PPE) shortages present a tremendous challenge to healthcare systems around the world due to the COVID-19 pandemic. The first “Aerosol Box” was introduced by Dr Hsien Yung Lai in late March 2020 [1], and since other companies and organizations have followed suit with their own versions, generally known as “intubation boxes” [2, 3] This simple solution to a difficult problem does not provide as much protection as many had hoped for. The COVID-19 virus is approximately 0.125 micrometres in diameter [6] It often travels in biological aerosols generated by coughing and sneezing, which range in size from 0.5-3 micrometres. Such particles are sufficiently large to be filtered through a HEPA filter. The pump generates a negative pressure with a flow rate of 170L/min, so all of the air inside the intubation box will be replaced in approximately 36 seconds
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