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Randomized Controlled Trial
. 2020 Oct;75(10):1301-1306.
doi: 10.1111/anae.15102. Epub 2020 May 28.

The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study

J Schumacher  1 , J Arlidge  1 , D Dudley  1 , M Sicinski  1 , I Ahmad  1
Affiliations
Randomized Controlled Trial

The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study

J Schumacher et al. Anaesthesia. 2020 Oct.

Abstract
in English, Korean

The current international COVID-19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air-purifying respirators and powered air-purifying respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq™; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered respirator group; however, noise levels were perceived to be significantly lower than in the standard respirator group. We conclude that standard and powered respirators do not significantly prolong simulated advanced intubation procedures.

현재 COVID‐19에 따른 국제적 보건 위기는 급성 기도 관 리 중 임상 교원을 위한 적절하고 적합한 개인 보호장비의 중 요성을 강조한다. 본 연구에서는 시뮬레이션한 어려운 기도 시 나리오에서 표준 공기 정화 호흡보호구와 전동식 공기 정화 호흡보호구의 영향을 비교하였다. 25명의 마취과 의사는 비보 호군(대조군), 표준 호흡보호구 또는 전동식 호흡보호구 착용 군으로 배정되어 네 가지 표준화된 어려운 기도 삽관 훈련을 수행하였다. 치료시간과 착용자의 편안함을 결정하고 비교하 였다. 착용자의 편안함 평가 양식에서는 이동성, 소음, 열, 시 각 및 말 명료도(speech intelligibility)를 평가하였다. 모든 마 취과 의사는 부작용 없이 모든 군의 치료 목표를 달성하였다. 네 가지 중재에 대한 총 평균(SD) 기도 삽관 시간은 전동식 호 흡보호구군 및 표준 호흡보호구군에서 유의한 차이를 보이지 않았다. AirtraqTM 사용시, 16.4초(8.6) vs. 19.2초(5.2); 비디오 후두경 사용시 11.4초(3.4) vs. 10.0초(2.1); 굴곡기관지경 사용 시, 39.2초(4.5) vs. 40.1초(4.8); 후두경을 사용한 표준 기도 삽 관시 15.4초(5.7) vs. 15.1초(5.0). 비디오후두경의 경우 사용하 는 호흡기 보호장치에 상관없이 기도 삽관 시간이 가장 짧았 다. 마취과 의사는 열과 시각을 전동식 호흡보호구군에서 유 의하게 높게 평가하였지만 소음 수준은 표준 호흡보호군보다 유의하게 낮다고 인식하였다. 저자들은 표준 호흡보호구 및 전동식 호흡보호구가 시뮬레이션된 어려운 기도 삽관을 유의 하게 연장하지 않는다고 결론지었다.

Keywords: CBRN; COVID-19; SARS-CoV-2; difficult airway management; personal protective equipment.

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Figures

Figure 1
Figure 1
Powered air‐purifying respirator with hood.
Figure 2
Figure 2
Standard air‐purifying respirator.
See this image and copyright information in PMC

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