Development and validation of the airway surgery enclosure for high-risk aerosol-generating airway procedures: a...

Procedures on the upper airway in patients with respiratory viruses are considered to carry the greatest risk of infection spread to operating room personnel through aerosolization. Appropriate personal protective equipment must be worn, but availability varies worldwide and resources may be limited. We describe the development, validation, and safe implementation of a reusable enclosure with an inexpensive, acrylic design, for use in high-risk airway procedures. Examples of common yet high-risk, aerosol-generating procedures performed with the Airway Surgery Enclosure (ASE) include laryngo-bronchoscopy, suspension laryngoscopy for removal of airway lesions, and rigid bronchoscopy including airway foreign body removal. The ASE demonstrated an 87-94% reduction in aerosolized particle concentration compared to ambient room levels. Bench testing validated the containment capability through laser-based particle imaging and air sampling, while clinical evaluations confirmed ergonomic feasibility and usability. While the ASE provides significant reductions in aerosol exposure, implementation challenges include integration with existing operating room workflows, material durability over repeated sterilization cycles, and cost considerations for widespread adoption. Further studies are needed to assess long-term clinical effectiveness and user adaptability.