Orotracheal intubation incorporating aerosol-mitigating strategies by anaesthesiologists, intensivists and emergency physicians: a simulation study

BackgroundOrotracheal intubation (OTI) can result in aerosolisation leading to an increased risk of infection for healthcare providers, a key concern during the COVID-19 pandemic.ObjectiveThis study aimed to evaluate the OTI time and success rate of two aerosol-mitigating strategies under direct lar...

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Bibliographic Details
Published in:	BMJ simulation & technology enhanced learning Vol. 7; no. 5; pp. 385 - 389
Main Authors:	Silveira, Saullo Queiroz, da Silva, Leopoldo Muniz, Ho, Anthony M-H, Kakuda, Cláudio Muller, Santos, Daniel Wagner de Castro Lima, Nersessian, Rafael Souza Fava, Abib, Arthur de Campos Vieira, de Sousa, Marcella Pellicciotti, Mizubuti, Glenio Bitencourt
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-07-2021 BMJ Publishing Group
Subjects:	Aerosols Airway management Coronaviruses COVID-19 Disease transmission Intensive care Intubation Original Research Pandemics Severe acute respiratory syndrome coronavirus 2 Simulation Success Ventilators COVID-19 intubation simulation
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Summary:	BackgroundOrotracheal intubation (OTI) can result in aerosolisation leading to an increased risk of infection for healthcare providers, a key concern during the COVID-19 pandemic.ObjectiveThis study aimed to evaluate the OTI time and success rate of two aerosol-mitigating strategies under direct laryngoscopy and videolaryngoscopy performed by anaesthesiologists, intensive care physicians and emergency physicians who were voluntarily recruited for OTI in an airway simulation model.MethodologyThe outcomes were successful OTI, degree of airway visualisation and time required for OTI. Not using a stylet during OTI reduced the success rate among non-anaesthesiologists and increased the time required for intubation, regardless of the laryngoscopy device used.ResultsSuccess rates were similar among physicians from different specialties during OTI using videolaryngoscopy with a stylet. The time required for successful OTI by intensive care and emergency physicians using videolaryngoscopy with a stylet was longer compared with anaesthesiologists using the same technique. Videolaryngoscopy increased the time required for OTI among intensive care physicians compared with direct laryngoscopy. The aerosol-mitigating strategy under direct laryngoscopy with stylet did not increase the time required for intubation, nor did it interfere with OTI success, regardless of the specialty of the performing physician.ConclusionsThe use of a stylet within the endotracheal tube, especially for non-anaesthesiologists, had an impact on OTI success rates and decreased procedural time.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2056-6697 2056-6697
DOI:	10.1136/bmjstel-2020-000757