Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis.
Br J Anaesth
; 125(6): 880-894, 2020 12.
Article
in English
| MEDLINE | ID: covidwho-796966
ABSTRACT
Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fifty-two articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Patient Isolation
/
Pneumonia, Viral
/
Coronavirus Infections
/
Aerosols
/
Airway Management
Type of study:
Observational study
/
Prognostic study
/
Reviews
Limits:
Humans
Language:
English
Journal:
Br J Anaesth
Year:
2020
Document Type:
Article
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