Comparing the Ease of Endotracheal Intubation with and without an Intubation Box in COVID-19 Patients
I-Box and ease of endotracheal intubation
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Abstract
Background: Endotracheal intubation is a potentially high-risk aerosol-generating procedure. So, an intubation box (I-Box) is designed for personal protection during intubation. This study aimed to compare the outcomes of endotracheal intubation with and without an I-box in COVID-19 patients.
Methods: In this study, 60 COVID-19 patients (30 patients in each group) with and without I-box groups were included. outcomes of intubation including duration of intubation, first-pass success intubation, suitable visibility of airways, restriction of movement in the neck, the need to surface maneuvering of the airway, and the number of attempts for successful intubation were compared between the two groups.
Results: The time of intubation was significantly longer in the I-box group (15.27±2.6 seconds) than without the I-box group (8.37±1.3 seconds) (p<0.001). All patients (100%) were intubated in the first attempt in the without I-box group while the rate of first-pass success intubation was 50% in the I-box group (p <0.001). The visibility of the airway was significantly better in the without I-box group than the I-box group (without I-box: 23 patients (76.7%), I-box: 15 patients (50%), p= 0.032). The frequency of need to optimizing maneuver of the airway was in without and with I-box was 23.3% and 50% respectively (p=0.032).
Conclusion: However, the I-box as a physical barrier can protect healthcare workers but its use increased the time to intubation and the number of attempts for successful intubation and reduced the rate of first-pass success intubation and visibility.
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[24] Laack TA, Pollok F, Sandefur BJ, Mullan AF, Russi CS, Yalamuri SM. Barrier Enclosure for Endotracheal Intubation in a Simulated COVID-19 Scenario: A Crossover Study. West J Emerg Med. 2020; 21(5):1080.
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[26] Vijayaraghavan S, Puthenveettil N. Aerosol box for protection during airway manipulation in covid-19 patients. Indian J Anaesth. 2020; 64(Suppl 2):S148.
[27] Malik J, Jenner C, Ward P. Maximising application of the aerosol box in protecting healthcare workers during the COVID‐19 pandemic. Anaesthesia. 2020; 75(7):974-975.
[28] Simpson J, Wong D, Verco L, Carter R, Dzidowski M, Chan P. Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID‐19 pandemic. Anaesthesia. 2020; 75(12):1587-95.
[29] Mahmudiono T, Singhal S, Mohammad AA, Failoc-Rojas VE, Catalan Opulencia MJ, Haro AS, et al. The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review. Expert Rev Med Devices. 2022; 19(10):779-789.
[30] Fong S, Li E, Violato E, Reid A, Gu Y. Impact of aerosol box on intubation during COVID-19: a simulation study of normal and difficult airways. Can J Anaesth. 2021; 68(4):496-504.
[31] Venketeswaran MV, Srinivasaraghavan N, Balakrishnan K, Seshadri RA, Sriman S. Intubation outcomes using the aerosol box during the COVID-19 pandemic: A prospective, observational study. Indian J Anaesth. 2021; 65(3):221-228.
[32] Lim ZJ, Reddy MP, Karalapillai D, Shekar K, Subramaniam A. Impact of an aerosol box on time to tracheal intubation: systematic review and meta-analysis. Br J Anaesth. 2021; 126(3):e122-e125.
[33] Turner JS, Falvo LE, Ahmed RA, Ellender TJ, Corson-Knowles D, Bona AM, et al. Effect of an aerosol box on intubation in simulated emergency department airways: A randomized crossover study. West J Emerg Med. 2020; 21(6):78-82.
[2] Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020; 16(10):1745-52.
[3] Bianco F, Incollingo P, Grossi U, Gallo G. Preventing transmission among operating room staff during COVID-19 pandemic: the role of the Aerosol Box and other personal protective equipment. Updates Surg. 2020; 72:907-10.
[4] Organization WH. COVID-19 weekly epidemiological update, 23 February 2021. 2021.
[5] Weissman DN, De Perio MA, Radonovich LJ. COVID-19 and risks posed to personnel during endotracheal intubation. Jama. 2020; 323(20):2027-8.
[6] Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol Head Neck Surg. 2020; 146(6):579-84.
[7] Ljubicic N, Stojsavljevic-Shapeski S, Virovic-Jukic L, Nikolic M. Plexiglas barrier box to improve ERCP safety during the COVID‐19 pandemic. Gastrointest Endosc. 2020; 92:428-9.
[8] Cook T, El‐Boghdadly K, McGuire B, McNarry A, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID‐19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia. 2020; 75(6):785-99.
[9] Brown H, Preston D, Bhoja R. Thinking outside the box: a low-cost and pragmatic alternative to aerosol boxes for endotracheal intubation of COVID-19 patients. Anesthesiology. 2020; 133(3):683-684.
[10] Zahid K, Ahmed ALD, Hesam Aldin V, Parsa M, Mostafa M. Early versus delayed intubation and technique in COVID-19. Arch Anesth & Crit Care. 2022; 8(1):60-67.
[11] Yang SS, Zhang M, Chong JJ. Comparison of three tracheal intubation methods for reducing droplet spread for use in COVID-19 patients. Br J Anaesth. 2020; 125(1):e190-e191.
[12] Cordier PY, De La Villeon B, Martin E, Goudard Y, Haen P. Health workers' safety during tracheostomy in COVID‐19 patients: Homemade protective screen. Head Neck. 2020; 42(7):1361-1362.
[13] Luo M, Cao S, Wei L, Tang R, Hong S, Liu R, et al. Precautions for intubating patients with COVID-19. Anesthesiology. 2020; 132(6):1616-1618.
[14] Lin L-W, Hung T-Y. Swivel-HEPA-ETT (SHE) bougie and HEPA-ETT (HE) methods for safe intubation while managing patients with COVID-19. Emerg Med J. 2020; 37(5):256-7.
[15] Yang Y-L, Huang C-H, Luk H-N, Tsai PB. Adaptation to the plastic barrier sheet to facilitate intubation during the COVID-19 pandemic. Anesth Analg. 2020; 131(2):e97-e99.
[16] Moraga FAL, Moraga EL, Moraga FL, González AJ, Celaya JMI, Gallegos JAO, et al. Aerosol box, an operating room security measure in COVID-19 pandemic. World J Surg. 2020; 44(7):2049-50.
[17] Begley J, Lavery K, Nickson C, Brewster D. The aerosol box for intubation in coronavirus disease 2019 patients: an in‐situ simulation crossover study. Anaesthesia. 2020; 75(8):1014-21.
[18] Jazuli F, Bilic M, Hanel E, Ha M, Hassall K, Trotter BG. Endotracheal intubation with barrier protection. Emerg Med J. 2020; 37(7):398-9.
[19] Dalli J, Khan MF, Marsh B, Nolan K, Cahill RA. Evaluating intubation boxes for airway management. Br J Anaesth. 2020; 125(3):e293-e295.
[20] Brown S, Patrao F, Verma S, Lean A, Flack S, Polaner D. Barrier system for airway management of COVID-19 patients. Anesth Analg. 2020; 131(1):e34-e35.
[21] Girgis AM, Aziz MN, Gopesh TC, Friend J, Grant AM, Sandubrae JA, et al. Novel coronavirus disease 2019 (COVID-19) aerosolization box: Design modifications for patient safety. J Cardiothorac Vasc Anesth. 2020; 34(8):2274-6.
[22] Azhar MN, Bustam A, Poh K, Zahedi AZA, Nazri MZAM, Ariffin MAA, et al. COVID-19 aerosol box as protection from droplet and aerosol contaminations in healthcare workers performing airway intubation: a randomised cross-over simulation study. Emerg Med J. 2021; 38(2):111-7.
[23] Clariot S, Dumain G, Gauci E, Langeron O, Levesque É. Minimising COVID-19 exposure during tracheal intubation by using a transparent plastic box: A randomised prospective simulation study. Anaesth Crit Care Pain Med. 2020; 39(4):461-3.
[24] Laack TA, Pollok F, Sandefur BJ, Mullan AF, Russi CS, Yalamuri SM. Barrier Enclosure for Endotracheal Intubation in a Simulated COVID-19 Scenario: A Crossover Study. West J Emerg Med. 2020; 21(5):1080.
[25] Feldman O, Samuel N, Kvatinsky N, Idelman R, Diamand R, Shavit I. Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study. PloS one. 2021; 16(3):e0248383.
[26] Vijayaraghavan S, Puthenveettil N. Aerosol box for protection during airway manipulation in covid-19 patients. Indian J Anaesth. 2020; 64(Suppl 2):S148.
[27] Malik J, Jenner C, Ward P. Maximising application of the aerosol box in protecting healthcare workers during the COVID‐19 pandemic. Anaesthesia. 2020; 75(7):974-975.
[28] Simpson J, Wong D, Verco L, Carter R, Dzidowski M, Chan P. Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID‐19 pandemic. Anaesthesia. 2020; 75(12):1587-95.
[29] Mahmudiono T, Singhal S, Mohammad AA, Failoc-Rojas VE, Catalan Opulencia MJ, Haro AS, et al. The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review. Expert Rev Med Devices. 2022; 19(10):779-789.
[30] Fong S, Li E, Violato E, Reid A, Gu Y. Impact of aerosol box on intubation during COVID-19: a simulation study of normal and difficult airways. Can J Anaesth. 2021; 68(4):496-504.
[31] Venketeswaran MV, Srinivasaraghavan N, Balakrishnan K, Seshadri RA, Sriman S. Intubation outcomes using the aerosol box during the COVID-19 pandemic: A prospective, observational study. Indian J Anaesth. 2021; 65(3):221-228.
[32] Lim ZJ, Reddy MP, Karalapillai D, Shekar K, Subramaniam A. Impact of an aerosol box on time to tracheal intubation: systematic review and meta-analysis. Br J Anaesth. 2021; 126(3):e122-e125.
[33] Turner JS, Falvo LE, Ahmed RA, Ellender TJ, Corson-Knowles D, Bona AM, et al. Effect of an aerosol box on intubation in simulated emergency department airways: A randomized crossover study. West J Emerg Med. 2020; 21(6):78-82.
| Files | ||
| Issue | Vol 10 No 3 (2024): Summer |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v10i3.15688 | |
| Keywords | ||
| Anesthesiologists COVID-19 Endotracheal intubation Health Personnel Personal Protective Equipment Respiratory Aerosols and Droplets | ||
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How to Cite
1.
Karami N, Mahoori A, Karami T, Shakeri A, Abtahi D. Comparing the Ease of Endotracheal Intubation with and without an Intubation Box in COVID-19 Patients. Arch Anesth & Crit Care. 2023;10(3):216-220.
