Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic - 18/12/20
, Cameron H. Good, PhD c, Benjamin K. Schilling, MS d, Robert W. Turer, MD, MSE f, Nicholas R. Karlowsky, BS g, Lucas A. Dvoracek, MD a, Heng Ban, PhD e, Jason S. Chang, MD b, J. Peter Rubin, MD a, d
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Abstract |
Study objective |
Throughout the coronavirus disease 2019 pandemic, many emergency departments have been using passive protective enclosures (“intubation boxes”) during intubation. The effectiveness of these enclosures remains uncertain. We sought to quantify their ability to contain aerosols using industry standard test protocols.
Methods |
We tested a commercially available passive protective enclosure representing the most common design and compared this with a modified enclosure that incorporated a vacuum system for active air filtration during simulated intubations and negative-pressure isolation. We evaluated the enclosures by using the same 3 tests air filtration experts use to certify class I biosafety cabinets: visual smoke pattern analysis using neutrally buoyant smoke, aerosol leak testing using a test aerosol that mimics the size of virus-containing particulates, and air velocity measurements.
Results |
Qualitative evaluation revealed smoke escaping from all passive enclosure openings. Aerosol leak testing demonstrated elevated particle concentrations outside the enclosure during simulated intubations. In contrast, vacuum-filter-equipped enclosures fully contained the visible smoke and test aerosol to standards consistent with class I biosafety cabinet certification.
Conclusion |
Passive enclosures for intubation failed to contain aerosols, but the addition of a vacuum and active air filtration reduced aerosol spread during simulated intubation and patient isolation.
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| Please see page 2 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: William R. Mower, MD, PhD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: DMT, CHG, BKS, NRK, LAD, HB, JSC, and JPR were responsible for study conceptualization and design. DMT, CHG, RWT, NRK, and JSC were responsible for literature review. DMT, CHG, BKS, RWT, NRK, HB, JSC, and JPR were responsible for data analysis and interpretation of results. DMT, CHG, RWT, JSC, and JPR were responsible for article development and review. DMT and CHG contributed equally to this work. DMT takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Drs. D. M. Turer, Good, Dvoracek, Ban, Chang, and Rubin and Mr. Schilling are named as inventors on a patent application assigned to the University of Pittsburgh. This work was supported by a University of Pittsburgh Center for Medical Innovation Grant (F_309-2020-Turer). |
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Vol 77 - N° 1
P. 1-10 - janvier 2021 Retour au numéro
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