The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review

ABSTRACT

Introduction

This study aimed to summarize the effect of the aerosol box on tracheal intubation in patients with COVID-19.

Areas covered

According to the PRISMA guidelines, a systematic search was performed to identify relevant literature on the ‘impact of the aerosol box on tracheal intubation during the COVID‐19 pandemic’ in different electronic databases up to March 2021. Based on a set of predefined inclusion and exclusion criteria, 447 articles were screened. Finally, 20 articles were included in the current systematic review. The findings showed that the use of aerosol box during intubation could reduce droplet contamination on the healthcare workers but not necessarily aerosols. An increase in the time of intubation with the aerosol box was also observed in 9 out of 12 studies (75%); however, three studies reported no significant difference in the time of intubation with and without the aerosol box. Most studies (8 out of 9, 89%) were also shown that intubation with the aerosol box may lead to more difficulty.

Expert opinion

The proceduralist and other healthcare workers involved in airway management of COVID-19 infected patients should decide whether to apply the aerosol box with caution, balancing between benefits and risks, especially in difficult airway circumstances.

KEYWORDS:

• Aerosol box
• COVID-19
• healthcare workers
• tracheal intubation
• systematic review

Article highlights

• COVID‑19 pandemic is extremely challenging for healthcare workers, especially those involved in aerosol-generating activities such as intubation, extubation, etc. The use of the aerosol box, as an innovative barrier, during aerosol-generating procedures such as intubation has been proposed.

• Although the use of the aerosol box may protect healthcare workers, potential drawbacks of using this device should be considered including technical difficulties in tracheal intubations (because of the limited space), increase in intubation time, and insufficient captures of produced aerosols (because of the potential air leaks from the box).

• In the present study, a systematic search was performed on the potential effects of aerosol box on tracheal intubation during the COVID‐19 pandemic.

• The use of aerosol box during intubation can reduce droplet contamination on the healthcare workers but not necessarily aerosols. The use of aerosol box also affects intubation time and technical difficulty. Furthermore, most studies (89%) were shown that intubation with the aerosol box may lead to more difficulty.

• According to the findings represented in this study, it can be concluded that the proceduralist and other healthcare workers involved in airway management of COVID-19 infected patients should make decisions on whether to apply the aerosol box with caution, balancing between benefits and risks, especially in difficult airway circumstances.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers in this manuscript have no relevant financial or other relationship to disclose.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author’s contributions

Trias Mahmudiono: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Supervision; Validation; Writing-original draft. Saurabh Singhal, Anas Amer Mohammad, Virgilio E Failoc-Rojas, Maria Jade Catalan Opulencia, Angel Santillán Haro: Data curation; Formal analysis; Investigation; Writing- original draft. Yasir Salam Karim, Nizom Qurbonov, Fahad Alsaikhan, Walid Kamal Abdelbasset: Data curation; Writing-original draft. Ahmed B. Mahdi, Yasser Fakri Mustafa: Investigation; Writing-review & editing.

Additional information

Funding

This paper was not funded.