Aerosol containment device for airway management of patients with COVID-19: a narrative review
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SPECIAL FEATURE: REVIEW ARTICLE Anesthesia in the Time of COVID-19
Aerosol containment device for airway management of patients with COVID‑19: a narrative review Tomoyuki Saito1 · Takashi Asai1 Received: 25 September 2020 / Accepted: 9 November 2020 © Japanese Society of Anesthesiologists 2020
Abstract Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. To protect healthcare workers from infection during airway management, some expert recommendations and guidelines recommended wearing P2/N95 masks, goggles or glasses, glove, face-shields, and gowns as standard personal protective equipment (PPE). Nevertheless, several simulation studies have suggested that the standard PPE may not fully protect healthcare workers. Dr. Hsien Yung Lai introduced an acrylic box (“aerosol box”) as a part of PPE during airway management. Since then, several companies and healthcare workers have made their own modified devices (“aerosol containment device”), and the use of such a device has spread worldwide, without being formally assessed for its effectiveness, efficacy and safety. Several simulation studies have indicated that “aerosol containment device” would make tracheal intubation more difficult. In addition, the device would prevent the spread of droplets from a patient, but may increase the risk of healthcare workers being exposed to a higher concentration of viral aerosols. Therefore, the current state of knowledge indicates that an “aerosol containment device” without vacuum mechanism has only limited efficacy in protecting healthcare workers from viral transmission. Keywords Aerosol box · COVID-19 · Tracheal intubation
Introduction Severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2), which causes coronavirus disease 2019 (COVID19), is highly contagious [1–4]. A considerable number of healthcare workers are believed to have been infected while treating patients with COVID-19, and some died of acute respiratory distress syndrome worldwide [3, 4]. Transmission of SARS-CoV-2 is thought to be predominantly through respiratory droplets or secretions from coughing and gagging, and through a spread of aerosols (usually defined as small airborne particles
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