ICU research on aerosol boxes reveals problems

While a barrier box to prevent the spread of aerosolised respiratory droplets from critically ill patients during intubation might seem like a good idea at first glance, a critical analysis by intensive care unit (ICU) practitioners reveals that's not necessarily so.

ICU specialists from Monash University and Cabrini Health teamed up to assess two different types of aerosol boxes that have been rapidly developed and sold. They found that aerosol boxes may increase intubation times and therefore expose patients to the risk of hypoxia (lack of oxygen).

Not only do the boxes slow down the process of intubating i.e. getting air into the patients. The tight seal on the armholes of the latest generation box is also an issue. On a number of occasions, either skin was exposed or gown sleeves were breached. As the authors say in the article, the boxes "may cause damage to conventional personal protective equipment and therefore place clinicians at risk of infection."

They conclude that further research is required before these devices can be considered safe for clinical use.

• 16 May 2020 SMH article link
•  J. L. Begley, K. E. Lavery, C. P. Nickson, D. J. Brewster. The aerosol box for intubation in COVID-19 patients: an in-situ simulation crossover study. doi: 10.1111/anae.15115