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Aerosol barriers in pediatric anesthesiology: Clinical data supports FDA caution
Nathaniel T G Tighe1,2, Craig D McClain1,2, Bistra G Vlassakova1,2
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Insights
Physical barriers for COVID-19 airway management may pose risks to pediatric patients. Initial experiences suggest these aerosol barriers can complicate pediatric intubations, potentially increasing patient harm.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Infectious Disease Control
Background:
- COVID-19 pandemic necessitated rapid development of aerosol barriers for provider safety during airway management.
- Aerosol barrier devices were implemented into perioperative workflows to mitigate airborne transmission risks.
Purpose of the Study:
- To report initial experiences with aerosol barrier devices in pediatric patients undergoing airway management.
- To evaluate potential risks and difficulties associated with using aerosol barriers in pediatric anesthesia.
Main Methods:
- A prospective quality improvement initiative involving simulation training and use of plastic aerosol barriers.
- Web-based surveys collected detailed feedback from experienced providers after cases.
- Data collected from 36 pediatric patients (1 month–18 years) with suspected or confirmed COVID-19.
Main Results:
- Sixteen point seven percent (16.7%) of cases experienced unexpected difficulty in securing the pediatric airway under an aerosol barrier.
- Four cases required multiple attempts, and two had pronounced difficulty, with barriers perceived as a contributing factor.
- Providers reported significant challenges in managing airways with these devices in pediatric patients.
Conclusions:
- Aerosol barriers may introduce unanticipated difficulties and risks during pediatric airway management.
- Potential for hypoxemia and patient harm exists due to these complications.
- This initial pediatric experience supports concerns and aligns with FDA's withdrawal of support for these barriers.
Background:
The onset of the COVID19 pandemic drove the rapid development and adoption of physical barriers intended to protect providers from aerosols generated during airway management. We report our initial experience with aerosol barrier devices in pediatric patients and raise concerns that they may increase risk to patients.
Methods:
In March 2020, we developed and implemented simulation training and use of plastic aerosol barrier devices as a component of our perioperative COVID-19 workflow. As part of our quality improvement process, we obtained detailed feedback via a web-based survey after cases were performed while using these aerosol barriers.
Results:
Between March and June 2020, 36 pediatric patients age 1mo-18years with anatomically normal airways and either PCR confirmed or suspected COVID-19 were intubated under an aerosol barrier as part of urgent or emergent anesthetic care at our institution. Experienced providers had more difficulty than expected in six (16.7%) of the cases with four cases requiring multiple attempts to secure the airway and two cases involving pronounced difficulty in a single attempt. The aerosol barrier was perceived as a contributing factor to difficulty in all cases.
Conclusion:
The use of barriers may result in unanticipated difficulties with airway management, particularly in pediatric patients, which could lead to hypoxemia or other patient harm. Our initial experience in pediatric patients is the first such report in patients and provides clinical data which corroborates the simulation data prompting the FDA to withdraw support of barriers.
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