Intubation strategy in COVID-19 era: An observational study

Area of Science:

• Anesthesiology
• Infectious Disease Control
• Medical Device Innovation

Background:

• Aerosol-borne infections, such as COVID-19, pose significant risks to healthcare professionals during airway management.
• Existing aerosol protection equipment, like the intubation box (IB), requires enhancement to improve safety and efficacy.

Purpose of the Study:

• To evaluate the impact of a modified intubation box (MIB) and transparent sheets (TS) on patient outcomes during airway management compared to the first-generation intubation box (IB).
• To assess the effectiveness of different airway devices and intubation techniques in minimizing aerosol generation and adverse events during the COVID-19 pandemic.

Main Methods:

• A modified intubation box (MIB) was developed by increasing dimensions and incorporating a heat and moisture exchanger with filter and suction catheter.
• The study compared the performance of the IB, MIB, and TS in terms of time to intubate, first-pass success rate, and airway-related adverse events (ARAEs).
• Patient outcomes and the need for mask ventilation were analyzed across different airway devices and protection methods.

Main Results:

• The modified intubation box (MIB) and transparent sheets (TS) significantly reduced the time to intubate compared to the initial intubation box (IB).
• First-pass success rates were highest with TS (100%), followed by MIB (5.2%) and IB (66.7%), with video laryngoscopes showing fewer adverse events.
• The need for mask ventilation, a potential aerosolization risk, was highest with the IB, while no breaches in personal protective equipment or staff infections were reported.

Conclusions:

• Video laryngoscopy is a favorable approach for airway management in the context of COVID-19.
• The modified intubation box (MIB) offers added protection and is a valuable addition to the equipment for managing airways in COVID-19 patients.
• Implementing enhanced aerosol protection equipment is crucial for safeguarding healthcare professionals during infectious disease pandemics.