Aerosol Box Research Articles

Using the Multicomponent Aerosol FORmation Model (MAFOR) to Determine Improved VOC Emission Factors in Ship Plumes.

International shipping's particulate matter primary emissions have a share in global anthropogenic emissions of between 3% and 4%. Ship emissions of volatile organic compounds (VOCs) can play an important role in the formation of fine particulate matter. Using an aerosol box model for the near-plume scale, this study investigated how the changing VOC emission factor (EF) for ship engines impacts the formation of secondary PM2.5 in ship exhaust plumes that were detected during a measurement campaign. The agreement between measured and modeled particle number size distribution was improved by adjusting VOC emissions, in particular of intermediate-, low-, and extremely low-volatility compounds. The scaling of the VOC emission factor showed that the initial emission factor, based on literature data, had to be multiplied by 3.6 for all VOCs. Information obtained from the box model was integrated into a regional-scale chemistry transport model (CTM) to study the influence of changed VOC ship emissions over the Mediterranean Sea. The regional-scale CTM run with adjusted ship emissions indicated a change in PM2.5 of up to 5% at the main shipping routes and harbor cities in summer. Nevertheless, overall changes due to a change in the VOC EF were rather small, indicating that the size of grid cells in CTMs leads to a fast dilution.

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial.

An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use. Simulation-based randomized trial, conducted from May to December 2021. Four pediatric simulation centers. Teams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Each team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales. A total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92-21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the "low" range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand ( p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales ( p < 0.05). The use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the "low" range, and there was no significant difference between airway provider and assistant.

A Study Comparing the Aerosol Box and Mayo Containment setup During Intubation in COVID-negative Indian Patients as a Learning Curve

ABSTRACT Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) is highly contagious. The use of other barrier techniques, in addition to personal protective equipment (PPE), to limit aerosolization and protect against contamination may also be helpful. Design: This is a prospective, randomized, single-blind, comparative study to compare the efficacy of aerosol box with the Mayo trolley containment setup during intubation. Materials and Methods: The two setups were compared for ease and time taken for intubation, restriction of hand movement, difficulty in accessing equipment, difficulty in railroading of endotracheal tube (ETT) over a bougie, and general satisfaction of operator during intubation using the C-MAC video laryngoscope. The mean time taken for endotracheal intubation (ETI) was compared using the unpaired t-test, and the rest of the categorical variables were presented as proportions and percentages. Results: The mean time taken for ETI using the Mayo trolley was 42.6 seconds as compared to 54.5 seconds with an aerosol box. The operator was more satisfied with the Mayo trolley setup. Conclusion: The Mayo trolley containment setup is an inexpensive and readily available alternative to the aerosol box in any setting, with a lesser time taken to intubation and lesser restriction of hand movement, easy accessibility of equipment, and easy railroading of ETT over a bougie.

Impact of ozonation on the formation of particulate nitrosodi-methylamine (NDMA) in atmosphere

The contribution of ozonation to the formation of particulate nitrosodi-methylamine (NDMA) in the aqueous aerosol phase was investigated using measurement data from 2018 in Seoul, Republic of Korea and a box model. The correlation between the NDMA concentration and aerosol liquid water content and box model results showed that aqueous aerosol phase reactions, including nitrosation and ozonation, might contribute to the formation of NDMA. The concentration of NDMA and the ratio of O3/dimethylamine exhibited a negative correlation, suggesting that the contribution of ozonation to NDMA formation may not be significant. Furthermore, when the daily concentration of NDMA exceeded 10 ng/m3, the pH was 3.96 ± 0.48, indicating that the impact of ozonation on NDMA concentration might not be significant. To quantitatively investigate the contribution of ozonation, the ozonation mechanism that forms NDMA was included in the box model developed in our previous study. The model results showed that the ozonation contributed to the ambient concentration of NDMA (7.9 ± 3.8% (winter); 1.9 ± 3.0% (spring); 10.0 ± 0.77% (summer); 3.6 ± 7.3% (autumn)). It is estimated that the relatively higher O3/NOx ratio in summer (1.63 ± 0.69; 0.64 ± 0.52 (winter); 1.14 ± 0.92 (spring); 0.52 ± 0.54 (autumn)) could enhance ozonation and that relatively lower pH in summer (2.2 ± 0.4; 5.3 ± 1.2 (winter); 3.9 ± 1.2 (spring); 3.9 ± 0.7 (autumn)) could hinder nitrosation compared to that in other seasons.

Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY Study)

The aerosol box has been used during the management of patients with COVID-19 to reduce health care practitioner (HCP) exposure during aerosol-generating medical procedures (AGMPs). Little is known about the effect of aerosol box use on HCP contamination and AGMP procedure time. To investigate whether use of an aerosol box during AGMPs reduces HCP contamination or influences the time to successful completion and first-pass success rate for endotracheal intubation (ETI) and laryngeal mask airway (LMA) insertion. This multicenter, simulation-based, randomized clinical trial was conducted from May to December 2021 at tertiary care pediatric hospitals. Participant teams performed 3 simulated patient scenarios: bag-valve-mask ventilation, ETI, and LMA insertion. During the scenarios, aerosols were generated using Glo Germ. Teams of 2 HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box). Statistical analysis was performed from July 2022 to February 2023. The aerosol box (or SplashGuard CG) is a transparent, plastic barrier covering the patient's head and shoulders with access ports allowing HCPs to manage the airway. The primary outcome was surface area of contamination (AOC) on participants. Secondary outcomes were time to successful completion and first-pass success rates for ETI and LMA insertion. A total of 64 teams (128 participants) were enrolled, with data from 61 teams (122 participants) analyzed. Among the 122 participants analyzed, 79 (64.8%) were female and 85 (69.7%) were physicians. Use of an aerosol box was associated with a 77.5% overall decreased AOC to the torso (95% CI, -86.3% to -62.9%; P < .001) and a 60.7% overall decreased AOC to the facial area (95% CI, -75.2% to -37.8%; P < .001) in airway HCPs. There was no statistically significant difference in surface contamination after doffing personal protective equipment between groups. Time to completing ETI was longer in the aerosol box group compared with the control group (mean difference: 10.2 seconds; 95% CI, 0.2 to 20.2 seconds; P = .04), but there was no difference between groups for LMA insertion (mean difference: 2.4 seconds; 95% CI, -8.7 to 13.5 seconds; P = .67). In this randomized clinical trial of aerosol box use in AGMPs, use of an aerosol box reduced contamination deposition on HCPs' torso and face predoffing; the use of an aerosol box delayed time to successful intubation. These results suggest that the incremental benefits of reduced surface contamination from aerosol box use should be weighed against delayed time to complete intubation, which may negatively affect patient outcome. ClinicalTrials.gov Identifier: NCT04880668.

Management of the Normal and Difficult Pediatric Airway: Unique Challenges in the Time of COVID-19.

This review focuses on the challenges faced by acute care healthcare workers in the management of the normal and difficult pediatric airway during the COVID-19 pandemic and how these protocols and practices evolved during the pandemic. The current state of knowledge on timing of surgery and anesthesia is also discussed. In the early days of the pandemic, information about the SARS-CoV-2 virus and disease process was scarce. Governmental, healthcare, and professional organizations created several guidelines to protect invaluable healthcare workers from the contagious virus while also delivering appropriate care to children with COVID-19. With the emergence of new studies and the deployment of new life-saving COVID-19 vaccines and other therapies, these guidelines evolved. The use of aerosol containment devices such as aerosol boxes and flexible barrier techniques was found to be ineffective in reliably containing virus particles while posing potential harm to both healthcare workers and patients. Also, the definition of aerosol-generating and dispersing medical procedures was vastly broadened. To date, use of appropriate personal protection equipment and COVID-19 vaccination are the most effective ways to protect healthcare workers and safely manage children infected with SARS-CoV-2 who require airway intervention. Evidence-based public health measures and appropriate personal protective equipment remain the best way to protect both healthcare workers and patients. As the virus and population evolve and COVID-19 vaccines become more widely available, clinicians must be willing to adapt to the emerging evidence of their impact on how safe pediatric perioperative care is delivered.

Efficiency, limitations, and familiarization of a novel negative pressure aerosol box for intubation: a simulation-based randomized crossover study.

This study aimed to introduce a novel negative pressure aerosol box (Carrycure Isolator) and to test its efficiency and limitations, with the hope of suggesting improvements and further directions. A novel aerosol box (Carrycure Isolator) was invented. A single-center, randomized, crossover simulation study of 28 emergency medicine physicians was designed. Three trials of each participant using an intubation manikin were conducted, including intubation without the aerosol box (trial A), intubation with the aerosol box (trial B), and intubation with the aerosol box after familiarization (trial C). The primary endpoint was the time to intubation. The secondary endpoints were first-attempt success, number of attempts, percentage of glottic opening score, and Cormack-Lehane view. Collected data were statistically analyzed for their significance. The median times to intubation of trials A, B, and C were 30.5 (interquartile range [IQR], 28.0-40.0 seconds), 59.0 (IQR, 50.0-75.5 seconds), and 34.0 seconds (IQR, 30.5-47.0 seconds), respectively. Post hoc analysis showed that the time to intubation in trial B was significantly longer than that in trial A (P<0.05), while that the time to intubation in trial C was significantly shorter than that in trial B (P<0.05). concerning secondary endpoints showed similar patterns. Participants reported performing intubation with Carrycure Isolator to be relatively difficult, necessitating significant arm movement and view restrictions while increasing their time to intubation. Physicians took a longer time to intubate a manikin using the Carrycure Isolator, a novel negative pressure aerosol box. However, the time was improved after a period of familiarization.

Performance of Aerosol Boxes for Endotracheal Intubation during the COVID-19 Pandemic with Systematic Review.

In the backdrop of the COVID-19 pandemic, endotracheal intubation using an aerosol box (AB) became the norm in the emergency department (ED) and the intensive care unit. We compared two models of AB with different dimensions to compare and identify a device that helps in reducing viral exposure without compromising successful airway management. We conducted this prospective observational study for 7 months (October 20-April 21) on 143 patients presenting with an acute airway compromise to the ED. All intubations were performed using one of the two models available. The primary outcome was time taken for intubation (TTI). The overall median time taken to intubate using any AB was 63 (interquartile range [IQR]: 46.2-87.7) s with an 81.9% first-pass success (FPS) rate. TTI for AB I was 67 (IQR: 53-106) s with a 76.3% FPS rate, while TTI for AB II was 57 (IQR: 44-75) s with an 85.9% FPS rate. TTI was much shorter without the use of an AB (34: IQR: 24-53 s) with a 92% FPS rate. Intubations done by emergency physicians with more than 2 years of experience were faster in both with or without AB when compared to intubations done by physicians with <2 years of experience. The use of an AB is associated with a longer TTI when compared to intubations done without an AB. TTI was relatively shorter when more experienced emergency physicians performed intubation. FPS rates were low with intubations done using AB.

The effect of using personal protective equipment and aerosol box in the emergency department on the intubation times.

Endotracheal intubation is a procedure commonly performed in the emergency department (ED). Endotracheal intubation poses a risk of exposure to infectious aerosol droplets. The present study aims to test the effect of using an aerosol box (AB) and personal protective equipment (PPE) on the intubation time while performing endotracheal intubation manikin. The study participants (11 emergency specialists, 11 emergency physicians, and 11 general practitioners) performed endotracheal intubation on a training manikin in three different airway simulations. Simulation 1 had neither PPE nor AB, simulation 2 had PPE, and simulation 3 had both PPE and AB. The intubation times, the number of intubation attempts, and the discomfort caused by the AB were recorded. There was no significant difference in the number of intubation attempts between the physicians according to their position and airway simulations (p > 0.05). There was a significant difference at all time points except for the time to endotracheal tube cuff inflation in three different airway simulations using PPE and an AB (p < 0.05). The median intubation times were longer using PPE and an AB. The use of PPE and an AB significantly increases the total intubation time.

Effectiveness of video tutorial on compliance of medical officers to sequence of intubation protocol in simulated Covid-19 patients

Introduction: The use of full PPE, aerosol box, and video laryngoscope are recommended when performing intubation on a Covid-19 patient. However, this technique may be difficult for medical officers unfamiliar with the intubation protocol sequence, especially for those with less experience in anaesthesia. Video tutorials may play a vital role in improving the technique. This study evaluated the compliance of medical officers in our anaesthesia department to the intubation protocol and the effect on compliance before and after viewing the video tutorial on the protocol. Methods: A total of 70 medical officers (n = 70) in the Department of Anaesthesia, Hospital Universiti Sains Malaysia, Kelantan participated in this study. The participants performed the intubation protocol sequence on a simulated Covid-19 mannequin. Participants then viewed a video tutorial after their initial attempt and repeated the intubation sequence afterward. The outcomes measured include the proportion of participants compliant with the intubation protocol, the association between years of experience and compliance, and the compliance score before and after the video tutorial. Results: There was no significant association between years of anaesthesia and compliance score (p = 0.058). A large proportion of the subjects were compliant (n = 57, 81.4%). There was a significant difference between initial and repeatedcompliance score post-video tutorial (p &lt; 0.05). Conclusion: Years of experience in anaesthesia was not a determining factor for compliance with the intubation protocol sequence on simulated Covid-19 patients. However, the video tutorial played a significant role in improving compliance withthe intubation sequence.

Prevention of submicron aerosolized particle dispersion: evaluation of an aerosol box using a pediatric simulation model

ABSTRACT Background and Aim: The SplashGuard CG (SG) is a barrier enclosure developed to protect healthcare workers from SARS-CoV-2 transmission during aerosol-generating procedures. Our objective was to evaluate the protection provided by the SG against aerosolized particles (AP), using a pediatric simulation model of spontaneous ventilation (SV) and noninvasive ventilation (NIV). Methods: An aerosol generator was connected to the airways of a pediatric high-fidelity manikin with a breathing simulator. AP concentrations were measured both in SV and NIV in the following conditions: with and without SG, inside and outside the SG, with and without suction applied to the device. Results: In the SV simulated setting, AP peaks were lower with SG: 0.1 × 105 particles/L compared to without: 1.6 × 105, only when the ports were closed and suction applied. In the NIV simulated setting, AP peaks outside the SG were lower than without SG (20.5 × 105 particles/L), whatever the situation, without suction (14.4 × 105particles/L), with suction and ports open or closed: 10.3 and 0.7 × 105 particles/L. In SV and NIV simulated settings, the AP peaks measured within the SG were much higher than the AP peaks measured without SG, even when suction was applied to the device. Conclusions: The SG seems to decrease peak AP exposure in the 2 ventilation contexts, but only with closed port and suction in SV. However, high concentrations of AP remain inside even with suction and SG should be used cautiously.

Aerosol boxes for airway management in coronavirus disease patients: a clinical retrospective study in Mexico

IntroductionSignificant concerns raise for the healthcare workers involved in airway management of patients diagnosed with coronavirus 2019 disease (COVID-19).Due to shortages of personal protective equipment (PPE), barrier enclosure systems such as aerosol box (AB) have been proposed worldwide. The aim of this study was to evaluate our experience using AB as protective equipment in patients with COVID-19 in a third-level center in Mexico.MethodsA retrospective study of COVID-19 patients requiring airway management using an AB in the Hospital Central Sur de Alta Especialidad de Pemex in Mexico City from March 1 to June 1, 2020. Antropometric data, pre-intubation vital signs, and laboratory tests were recorded; the primary endpoints were intubation success rate and complications associated with AB and patients’ mortality. As a secondary endpoint, AB subjective evaluation was explored by administering a survey after airway management procedures.ResultsThirty-nine patients for a total of 40 intubations were documented. Thirty-one (77.5%) were men, with a mean age of 61.65 years; successful intubation occurred in 39 (97.55%) of the procedures, and AB was used in 36 (90%) of intubations, with success in 28 (70.0%); A Cormack-Lehane grade 3 view was recorded in 18 patients (46.2%), and during the procedure, the AB had to be removed in 8 (22.2%) cases, with migration documented in 91.6% of cases. The 30-day mortality was 48.71%, with 23.0% of patients discharged. 83.3% of surveyed anesthesiologists reported significant limitations in manipulating airway devices with AB used.ConclusionOur data indicate that in clinical practice, the use of AB may hinder airway management and decrease the intubation success rate and may also result in patients’ injury. Further studies are necessary to validate the use of AB in clinical practice, and they should not replace certified PPE.

A Method for Preventing Aerosols During Dental Treatment With an Oroscope.

Dentists have a much higher risk of exposure to coronavirus disease (COVID-19) than other healthcare workers. The virus is transmitted primarily through respiratory droplets and close/direct contact. Aerosol propagation is also possible in the case of prolonged exposure to high concentrations in a relatively closed environment. In this report, we describe the use of an aerosol box model to prevent aerosol generation during dental procedures. This report serves to inform clinicians on the potential effectiveness of this stopgap measure in cases where aerosol-generating procedures are unavoidable and medical supplies and personal protective equipment are in short supply.

A Dome-Shaped Aerosol Box for Protection During a Pandemic.

With the rise of COVID-19, the use of aerosol boxes when interacting with COVID-19 patients has increased. However, their use has been controversial.We have been involved in the development of a dome-shaped aerosol containment device with negative pressure (DAWN), an aerosol box that can maintain negative pressure inside at all times.There are two types of DAWN: one is mounted on a bed (bed type) and the other is mounted on a stretcher (stretcher type). Each device has its own characteristics and can be selected depending on the situation. The bed type has enough space inside to allow procedures to be performed easily. The stretcher type can be attached to a stretcher and can maintain negative pressure when the patient is being moved. Due to the negative pressure structure and easy change of nonwoven fabric adopted in both types of DAWN, it is expected to prevent the scattering of aerosol when it is removed, which is a problem of conventional aerosol boxes.DAWN will contribute to reducing the enormous psychological stress of medical personnel who treat infections, and will contribute to reducing aerosol dispersion.

Comparison of aerosol box intubation with styletted endotracheal tube and intubation over bougie: A randomized controlled trial.

Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is an infectious disease. The use of video laryngoscopes is recommended for intubation of patients with COVID-19. But in resource-poor countries, it is rare to have video laryngoscopes available. In this trial, we have compared the ease of oral intubation by direct laryngoscopy with styletted endotracheal tube and intubation over the bougie, with the use of the aerosol box. The secondary objectives were comparison of the incidence of airway loss, attempts taken to intubate, time for intubation and hemodynamic changes. 80 non-coronavirus infected patients coming for an elective procedure under general anesthesia were recruited in this randomized control trial. Participants were assigned into groups S and B using a computer-generated random sequence of numbers by closed envelope technique. In both groups, aerosol box was used. In Group S, participants were intubated by direct laryngoscopy with a styletted endotracheal tube and in group B, after direct laryngoscopy, the endotracheal tube was railroaded over the bougie. Ease of endotracheal intubation was good (67.5%% vs. 45%), satisfactory (32.5%% vs. 37.5%), and poor (0% vs. 17.5%) in group S and B respectively (P < 0.011). The attempts required for intubation were similar in both groups. The time for intubation was significantly less in group S than B (23 vs. 55 s). The use of a styletted endotracheal tube made intubation easier and faster than tracheal intubation with bougie when the aerosol box was used in patients without known or predicted difficult airway and significant medical comorbidities.

Evaluation of aerosol box use for ultrasound-guided internal jugular vein cannulation in patients with COVID-19: A short-term randomised study.

Background and Aims:During the coronavirus disease 2019 (COVID-19) pandemic, health care workers are at a high risk of infection from aerosols. In this study, we compared the ease of using the aerosol box (AB) with the traditional method during internal jugular vein cannulation attempts (IJVCA).Methods:The study included 40 patients with COVID-19 who required central venous catheterisation during treatment in the ward. The patients were randomly allocated to one of the two protective equipment (PPE) groups and then randomly assigned to one of the five anaesthesiologists with at least 5 years of experience. Group P and A had both PPE and AB used, whereas Group P included patients where PPE was used alone. The physicians completed a survey after performing the procedure to evaluate the use of the AB.Results:The preparation for the procedure and procedure durations were observed to be statistically longer in Group P and A (P = 0.002 and P = 0.001, respectively). The first attempt in Group P and A was unsuccessful in six patients, whereas the first attempt in Group P was unsuccessful in only two patients (P = 0.235). Anaesthesiologists described difficulty with manipulation during the procedure, discomfort using the box, and resulting cognitive load increase in Group P and A.Conclusion:The IJVCA procedures were faster and easier and had greater satisfaction for physicians when the AB was not used. Also, the high complication rate, including carotid artery punctures and disruption of sterility and PPE, albeit not statistically significant, has clinical implications. Therefore, we do not recommend the use of ABs for IJVCA.

The Comparison of Duration Endotracheal Tube Insertion Using Aerosol Box And without Aerosol Box in Elective Surgery Patients in the Covid-19 Pandemic

Introduction. The aerosol box can reduce the risk of droplet and aerosol transmission from the patient to the operator when performing intubation, but in practice, an aerosol box makes the glottis visualization less evident, and the operator moves less space with less space the aerosol box. This study aimed to compare ETT duration using an aerosol box and without an aerosol box using a video laryngoscope.&#x0D; Methods: This study was a clinical trial with a post-test-only control design. The study was carried out from February 2021 to May 2021 at the Central Operating Theater of dr. Mohammad Hoesin General Hospital Palembang. The sample in this study was all patients who underwent elective surgery under general anesthesia using intubation at the Central Surgical Installation of dr. Mohammad Hoesin Palembang. After the data is collected, it is analyzed using the SPSS 22.0 program with the appropriate test.&#x0D; Results. There were no differences in subject characteristics (age, sex, BMI, Mallampati score, TMD, Cormack Lehane, limited mouth opening, short neck, limited mouth movement) between the group using the aerosol box and the group without the aerosol box. The duration of intubation without an aerosol box is 30.67 + 2.63 seconds, and using an aerosol box is 44.53 + 2.89 seconds. There was a significant difference between the two groups in the duration of patient intubation (p &lt; 0.001). However, there was no significant difference in complications in the two groups (p &gt;0.05).&#x0D; Conclusion. The duration of the endotracheal tube insertion using an aerosol box is more extended than without an aerosol box in elective surgery patients.

Comparison between Direct Laryngoscopy with and without Aerosol Box for Intubation in Patients Undergoing General Anaesthesia during COVID-19 PandemicA Randomised Controlled Study

Introduction: The airway management of patients with COVID19 is a high risk task for anaesthesiologists. Several innovations have been born as a result of this problem, including aerosol boxes and clear plastic sheets. Aim: To compare the timing and attempt of direct laryngoscopy with and without aerosol box for intubation in patients undergoing general anaesthesia during the COVID-19 pandemic. Materials and Methods: This was a randomised controlled study was conducted in Parul Sevashram Hospital, Parul University, Vadodara, Gujrat, India from April 2021 to September 2021. A total of 50 patients were randomly divided into two equal groups as group A was intubated with an aerosol box and a macintosh laryngoscope, while group B was intubated with a clear plastic sheet and macintosh laryngoscope. With proper airway precautions and Personal Protective Equipments (PPE) comparative assessment of patients undergoing surgery in general anaesthesia was done. Time to intubate, number of attempts, ease of Endotracheal Tube (ETT) tube insertion, quality of Laryngoscopy view and Cormack Lehane scores were assessed in both the groups. Results: The mean time for intubation was high at 29.72 seconds in group A, while it was 23.16 seconds in group B; the difference was significant. Overall, 20 out of 25 (80%) patients could be intubated in 1st attempt in group B as compared to 15 out of 25 (60%) in group A. Airway visualisation using Percentage of Glottic Opening (POGO) scoring and Cormack Lehane staging were suggestive of better visualisation in group B than group A. Difficulties encountered during intubation like laryngoscopy, glottic visualisation, arm movement restriction, ETT negotiation, and stylet removal were lesser in group A as compared to group B. The incidence of complications like sore throat and airway bleeding were lower in group B as compared to group A. Conclusion: In the COVID-19 era, aerosol box and clear plastic sheets are effective barrier measures for airway management to prevent the anaesthesiologists from the aerosol transmission. But airway management with clear plastic sheet is technically easier than aerosol box.

Modern modified aerosol box: Isolation aid for oral health care professionals during dental procedures.

COVID-19 affected healthcare professionals globally, especially dentists, which is airborne and transmitted through contact. Most dental procedures are aerosol generated and these aerosols in dental practice tend to transmit acute respiratory infections like COVID-19. Recently, a few authors recommended using the aerosol box to reduce the aerosol count in a dental setting. However, the study aims to describe and recommend a reformed aerosol box desand to practice safe dentistry.

Airway management practices in COVID ICU during the first and second phases of the pandemic: our experience

Various airway management devices and techniques have been revised and recommended to be used in COVID patients.1 In India, during the first wave (April 2020 to November 2020)2 the intubation strategy included: consultant-led intubation teams, the use of video laryngoscope (VL) and aerosol box (AB).3 During the second wave (April 2021 to June 2021),2 the intubation procedures were modified according to the availability of the resources, manpower, and some experience gained from the first wave.&#x0D; Key words: Airway management; COVID-19; Pandemic; Intensive care&#x0D; Citation: Nazir N, Saxena A. Airway management practices in COVID ICU during the first and second phases of the pandemic: our experience. . Anaesth. pain intensive care 2021;25(6):834–835;&#x0D; DOI: 10.35975/apic.v25i6.1716 &#x0D;