Izpostavljenost okužbi zdravstvenih delavcev zaradi pandemije covida-19 je privedla do razvoja novih oblik osebne varovalne opreme. Ena od njih je aerosolna škatla, ki je bila zasnovana z idejo, kako ...varneje vstaviti dihalno cevko v sapnik bolnikom, okuženim z virusom SARS-CoV2. Uporaba aerosolne škatle ne sega samo v področje anesteziologije, ampak tudi v druga področja medicine. Številne kritike na račun prvotne zasnove so vodile v izdelavo novih oblik, ki postopoma izboljšujejo prvotne pomanjkljivosti. Razvoj se usmerja predvsem v okoliščino, kako zmanjšati oviranost kirurga (ali izvajalca) pri posegih ter kako zagotoviti varnejšo, enostavnejšo in hitrejšo možnost uporabe. Številnim avtorjem je uspelo pokazati, da uporaba aerosolne škatle pomembno vpliva na hitrost vstavitve dihalne cevke v sapnik, zato v urgentnih primerih odsvetujejo uporabo aerosolne škatle. Ob primerni uporabi ter ustreznem urjenju zdravstvenega delavca pa se je izkazala kot učinkovita osebna varovalna oprema, ker zdravstvene delavce dobro zaščiti pred velikimi in majhnimi vodnimi kapljicami. Pravilno posodobljena oblika aerosolne škatle dobro varuje tudi pred aerosolnimi delci, medtem ko uporaba izvorne oblike lahko tveganje za okužbo zdravstvenega delavca z aerosolnimi delci še poveča.
Dear Editor, Aerosol contaminated with SARS-CoV-2 can spread out, even when wearing full personal protective equipment (PPE). ...protective box covering patient's head during airway management should ...be useful. The following parameters were measured: time to airway device placement (defined as the interval between grasping the laryngoscope/I-Gel and first successful breath indicated by the manikin), rate of first-pass success and visual analogue scale (VAS) for airway device placement and patent airway maintenance difficulty with and without protective box (subjectively assessed by the anaesthetist on a 100 mm scale ranging from 0 = extremely easy to 100 = extremely difficult). ...our results suggest that on average the prolongation time (of 9 s with DL and 4 s with VL) is probably not clinically relevant. Since extubation procedures bear significantly higher risk (0.2–6%) 4 of contact between patient sputum and the eye-, nose- or mouth-region of the healthcare worker than intubation procedures, we believe that such protective box would be especially useful for extubation procedures, to minimize the risk of contamination of the procedure room.
Because the SARS-CoV-2 virus primarily spreads through droplets and aerosols, a protective box could provide adequate protection by shielding medical professionals during the intubation and ...extubation procedures from generated droplets and aerosols. In this study, size- and time-dependent aerosol concentrations were measured inside and outside the protective box in the particle size ranging from 14 nm to 20 μm during simulated intubation and extubation procedures. An improved protective box with active ventilation was designed based on a plastic bag with armholes covered with latex sheets that utilizes a supportive frame. Coughing during the intubation and extubation procedure was simulated using an aerosol generator which dispersed the aerosol powder into the protective box. During the intubation and extubation procedure, the concentration of particles increased inside the protective box but, due to the high negative airflow, quickly dropped to background levels. The particle concentration of all measured particle sizes decreased within the same time frame. No leakage of particles was observed through the armhole openings. The presented protective box design provides excellent protection against generated droplets and aerosols. The decrease in concentration does not depend on the particle size. Outside the box, particle concentration did not change with time.
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