This study compares two intubation boxes, that is the Taiwan "Aerosol Box" versus the UMMC "Intubation Box". The importance of this intubation box has come to light recently in view of the COVID-19 pandemic and the fact that intubation is an aerosol-generating procedure. Risks of the healthcare worker attending to the airway of COVID-19 patients is high and the intubation box aims to minimize that and reduce contamination of the environment. The original design of the "Aerosol Box" has limitations and is not easily used by intubators. This study evaluates the clinical usefulness of an innovation of the "Aerosol Box" design that is made to be more ergonomic and increases the rate of successful intubation. Anaesthetists with more than 5 years of clinical experience in intubating airways as well as more than 20 successful intubations using videolaryngoscopy , will be available to participate. This study will employ manikin and will be a randomized cross-over trial, conducted in UM.
Background:
Intubation is classified as an aerosol-generating procedure (AGP). Intubation in a confirmed
COVID-19 patient with a high viral load poses a high risk of exposure to health care workers
(HCW). To reduce this risk, the HCW and their assistants are advised to don full personnel
protective equipment (PPE) with a powered air purifying respiratory (PAPR) during intubation.
In view of this concern, this procedure is highly recommended to be done in a negative
pressure room to control the spread of aerosolizing particles in the room. A first-pass
success in intubation is also crucial to minimize the risk of infection to health care
workers involved.
Introduction :
An Aerosol Box (from here on known as Box A) was recently designed by Dr. Lai Hsien Yung from
Taiwan which adds extra protection to the intubator and the surrounding environment. The
Aerosol Box is a transparent box made of acrylic or transparent polycarbonate sheet, designed
with an opening on one side allowing it to fit over the patient's chest and neck, while the
opposing side has two holes through which the intubator can insert their hands through. It
was shown that this barrier enclosure during intubation protects the laryngoscopist. A recent
study simulated a patient with a cough during intubation with and without the Aerosol Box.
With the box, it was demonstrated that the simulated cough resulted in contamination of only
the inner surface of the box, the laryngoscopist's gloves and gowned forearms. Examination of
the laryngoscopist and the room with ultraviolet light after the simulated cough also showed
no macroscopic contamination outside the box. In contrast, intubation without the box
demonstrated that the laryngoscopist's gown, gloves, face mask, eye shield, hair, neck, ears,
and shoes were all contaminated.
Feedbacks from our colleagues stated that intubation with Box A is slightly difficult and may
cause delay in intubation. Canelli et al also concluded this observation. The investigators,
therefore, innovated the design of Box A to facilitate the laryngoscopist, known as the UMMC
Intubation Box (from here on known as Box B).
Device: Aerosol Box
Usage of an Intubation Box to minimize intubator and environment contamination during intubation and extubation. Time taken for first-pass success if also expected to be reduced with the usage of the Intubation Box.
Device: Intubation Box
Usage of an Intubation Box to minimize intubator and environment contamination during intubation and extubation. Time taken for first-pass success if also expected to be reduced with the usage of the Intubation Box.
Inclusion Criteria:
- anaesthetists with more than 5 years of clinical experience AND more than 20
successful intubations using a videolaryngoscope
Exclusion Criteria:
- anaesthetists with less than 5 years of clinical experience AND/OR less than 20
successful intubations using a videolaryngoscope
University Malaya Medical Centre
Kuala Lumpur, Selangor, Malaysia
Investigator: SHAIRIL R RUSLAN, MAnaes(UM)
Contact: 0123291074
shairil@ummc.edu.my
SHAIRIL R RUSLAN, MAnaes(UM)
+60123291074
shairil@ummc.edu.my
MOHD F ZAINAL ABIDIN, MAnaes
+60162823181
m.fitry@ummc.edu.my
INA I SHARIFFUDDIN, MAnaes, Study Director
University of Malaya