Abstract
Emergency physicians are at risk of infection during invasive procedures, and wearing a respirator can reduce this risk. The aim of this study was to determine whether the protection afforded by a respirator during intubation is affected by the type of airway device used. In this randomized crossover study, 26 emergency physicians underwent quantitative fit tests for a N95 respirator (cup-type or fold-type) before and during intubation with a direct laryngoscope, GlideScope®, or i-gel® airway device. The primary outcome was the fit factor value of the respirator and the secondary outcome was the level of acceptable protection provided (percentage of fit factor scores above 100). Compared with the GlideScope and i-gel device, the fit factor values and level of acceptable protection provided were lower when physicians wore the cup-type respirator while intubating using the direct laryngoscope (200 fit factor [152–200] and 200 fit factor [121.25–200] versus 166 fit factor [70–200], 100% and 100% versus 75%, respectively; all P < 0.001). There were no significant differences in the fit factor value or level of acceptable protection provided when the physicians wore the fold-type respirator while intubating using any of the three airway devices (all P > 0.05). The type of airway device used for endotracheal intubation may influence the protective performance of some types of respirators. Emergency physicians should consider the effects of airway device types on fit factor of N95 respirators, when they perform intubation at risk of infection.
Highlights
Emergency physicians are the front-line health care workers at highest risk of exposure to airborne and aerosolized infectious hazards during invasive and emergency procedures, such as endotracheal intubation [1]
Fit factor values during intubation using each type of airway device while wearing a cup-type respirator
The fit factor value and protection afforded by the cup-type respirator when the Macintosh laryngoscope was used were lower than those of the other two airway devices (P < 0.05; Table 2)
Summary
Emergency physicians are the front-line health care workers at highest risk of exposure to airborne and aerosolized infectious hazards during invasive and emergency procedures, such as endotracheal intubation [1]. Protective performance of respirators when intubating using different devices recommend use of an N95 filtering facepiece respirator [2,3,4]. A direct laryngoscope is used as a first-line airway device during endotracheal intubation [11,12]. Movement during endotracheal intubation using a direct laryngoscope has been reported to influence the protective performance of respirators [16]. To the best of our knowledge, there are no reports on the effect of movement during endotracheal intubation using the various types of airway devices on the protective performance of respirators. The aim of this study was to determine whether different types of airway devices affect the protection afforded by a respirator during endotracheal intubation
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