Effect of intubation barrier devices on aerosol exposure

Editor's Note

Barrier devices used for intubation may reduce operator exposure to infectious droplets and aerosols, but there is wide variation in aerosol containment, this study finds.

Fully enclosed barrier devices reduced vapor and aerosol content in the area of the operator. If no barrier device was used, aerosol content was 1 order of magnitude higher than when using a fully enclosed device.

Semiclosed barriers caused vapor and aerosol leakage through the arm apertures and increased aerosol content at the operator’s face. Aerosol spread toward the operator was increased if the caudal side of the semiclosed barrier was closed.

Regular hospital suction inside the barrier was insufficient to redirect airflow away from the operator, but a smoke evacuator did direct airflow away.

Semiopen devices reduced aerosol content in the operator’s area, but this reduction was generally less consistent than semiclosed devices, and aerosol content was concentrated at the arm holes.

Use of a simple drape resulted in inconsistent reductions in aerosol content compared to no barrier. Vapor and aerosols escaped once the drape was lifted for airway manipulations.

Based on the findings, barrier devices should only be used as an adjunct to standard PPE for intubation, the researchers say.