Simulated Aerosol Retention of Covid Intubation Boxes (1090-003993) (To be presented during the session entitled, Research Abstract Oral: COVID-19)
Start time: Friday, January 22, 2021, 9:30 AM End time: Friday, January 22, 2021, 10:30 AM Session Type: Research Abstracts (Completed Studies)
Data that disease severity in COVID-19 may be correlated with inoculation dose has triggered interest in airway barrier devices. While recent work demonstrated reduced droplet exposure (1-6), aerosol protection is not understood.
Aerosol containment within barrier devices was investigated: (1) “Glove Box” : Box sealed with gloves and caudal drape, (2) “Drape Tent”, drape placed over a frame at the patient’s head , (3) “Slit Box”, armholes covered by a vinyl slit diaphragm and caudal covering, (4) Original “Aerosol Box”, (5) “Interlocking Box”, a collapsible polycarbonate box, (6) “Simple Drape”, a clear drape over the patient with the laryngoscopist’s hands beneath the drape, and (7) No Barrier. Containment was investigated using a Laerdal ALS man manikin by (1) installation of vapor with video-assisted visual examination (2) submicrometer ammonium sulfate aerosol particles ejected through the manikin’s mouth with simulated ventilation and coughs. Samples taken at standardized locations were evaluated using a condensational particle counter and an aerosol mass spectrometer. Smoke evacuation with hospital suction, a smoke evacuator and a ShopVac were investigated.
Vapor experiments demonstrated leakage via arm holes and edges. . With all barrier devices aerosol counts at the operator outer side were significantly elevated above baseline (p<0.001). Glove Box and Drape Tent reduced aerosol at the operator’s mouth and chest 10-fold compared to no barrier, with risk of leakage upon movement for laryngoscopy. With not fully enclosed devices aerosol at the operator’s body was equal or higher than without barrier, especially when used with a caudal drape. Aerosol evacuation to baseline required 15 min with suction and ShopVac, and 5 min with smoke evacuator
Glove Box and Drape Tent can retain most aerosol during airway management, different from all other devices. Not fully enclosed devices may direct aerosol toward the laryngoscopist. Aerosol evacuation for fully enclosed devices is advantageous.