A novel negative pressure isolation device reduces aerosol exposure: A randomized controlled trial.

Background and aim: The COVID-19 pandemic has led to a proliferation of intubation barriers designed to protect healthcare workers from infection. We developed the Suction-Assisted Local Aerosol Containment Chamber (SLACC) and tested it in the operating room. The primary objectives were to determine the ease and safety of airway management with SLACC, and to measure its efficacy of aerosol containment to determine if it significantly reduces exposure to health care workers. Methods: In this randomized clinical trial, adult patients scheduled to undergo elective surgery with general endotracheal anesthesia were screened and informed consent obtained from those willing to participate. Patients were randomized to airway management either with or without the SLACC device. Patients inhaled nebulized saline before and during anesthesia induction to simulate the size and concentration of particles seen with severe symptomatic SARS-CoV-2 infection. Results: 79 patients were enrolled and randomized. Particle number concentration (PNC) at the patients' and healthcare workers' locations were measured and compared between the SLACC vs. control groups during airway management. Ease and success of tracheal intubation were recorded for each patient. All intubations were successful and time to intubation was similar between the two groups. Healthcare workers were exposed to significantly lower particle number concentrations (#/cm3) during airway management when SLACC was utilized vs. control. The particle count outside SLACC was reduced by 97% compared to that inside the device. Conclusions: The SLACC device does not interfere with airway management and significantly reduces healthcare worker exposure to aerosolized particles during airway management.

A Novel Negative Pressure Isolation Device for Aerosol Transmissible COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic creates a need to protect health care workers (HCWs) from patients undergoing aerosol-generating procedures which may transmit the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Existing personal containment devices (PCDs) may protect HCWs from respiratory droplets but not from potentially dangerous respiratory-generated aerosols. We describe a new PCD and its aerosol containment capabilities. The device ships flat and folds into a chamber. With its torso drape and protective arm sleeves mounted, it provides contact, droplet, and aerosol isolation during intubation and cardiopulmonary resuscitation (CPR). Significantly improved ergonomics, single-use workflow, and ease of removal distinguish this device from previously published designs.

A national survey of airway management training in United States internal medicine-based critical care fellowship programs.

BACKGROUND: Intensivists may be primarily responsible for airway management in non-operating room locations. Little is known of airway management training provided during fellowship.Our primary aim was to describe the current state of airway education in internal medicine-based critical care fellowship programs. METHODS: Between February 1 and April 30, 2011, program directors of all 3-year combined pulmonary/critical care and 2-year multidisciplinary critical care medicine programs in the United States were invited to complete an online survey. Contact information was obtained via FRIEDA Online (https://freida.ama-assn.org). Non-responders were sent automated reminders, were contacted by e-mail, or by telephone. RESULTS: The overall response proportion was 66% (111/168 programs). Sixty-four (58%) programs reported a designated airway rotation, chiefly occurring for 1 month during the first year of training. Thirty-five programs (32%)reported having a director of airway education and 78 (70%) reported incorporating simulation based airway education. Nearly all programs (95%) reported provision of supervised airway experience during fellowship. Commonly used airway management devices, including video laryngoscopes,intubating stylets, supraglottic airway devices, and fiberoptic bronchoscopes, were reportedly available to trainees. However, 73% reported < 10 uses of a supraglottic airway device, 60% < 25 uses of intubating stylets, 73% < 30 uses of a video laryngoscope, and 65% reported < 10 flexible fiberoptic intubations. Estimates of the required number of procedures to ensure competence varied widely. CONCLUSIONS: The majority of programs have a formal airway management program incorporating a variety of intubation techniques. Overall experience varies widely, however.

A two-handed jaw-thrust technique is superior to the one-handed "EC-clamp" technique for mask ventilation in the apneic unconscious person.

BACKGROUND: Mask ventilation is considered a "basic" skill for airway management. A one-handed "EC-clamp" technique is most often used after induction of anesthesia with a two-handed jaw-thrust technique reserved for difficult cases. Our aim was to directly compare both techniques with the primary outcome of air exchange in the lungs. METHODS: Forty-two elective surgical patients were mask-ventilated after induction of anesthesia by using a one-handed "EC-clamp" technique and a two-handed jaw-thrust technique during pressure-control ventilation in randomized, crossover fashion. When unresponsive to a jaw thrust, expired tidal volumes were recorded from the expiratory limb of the anesthesia machine each for five consecutive breaths. Inadequate mask ventilation and dead-space ventilation were defined as an average tidal volume less than 4 ml/kg predicted body weight or less than 150 ml/breath, respectively. Differences in minute ventilation and tidal volume between techniques were assessed with the use of a mixed-effects model. RESULTS: Patients were (mean ± SD) 56 ± 18 yr old with a body mass index of 30 ± 7.1 kg/m. Minute ventilation was 6.32 ± 3.24 l/min with one hand and 7.95 ± 2.70 l/min with two hands. The tidal volume was 6.80 ± 3.10 ml/kg predicted body weight with one hand and 8.60 ± 2.31 ml/kg predicted body weight with two hands. Improvement with two hands was independent of the order used. Inadequate or dead-space ventilation occurred more frequently during use of the one-handed compared with the two-handed technique (14 vs. 5%; P = 0.013). CONCLUSION: A two-handed jaw-thrust mask technique improves upper airway patency as measured by greater tidal volumes during pressure-controlled ventilation than a one-handed "EC-clamp" technique in the unconscious apneic person.