Comparison Of Intubation Characteristics Using Intubation Box And Plastic Sheets: A Simulation Based Pilot Study

Background: There is paucity of literature documenting the intubation characteristics using ancillary protective gears innovated during pandemic times. We conducted a simulation based pilot study to compare the intubation characteristics with the use of intubation box (IB) and plastic sheet (PS) using both direct laryngoscope and videolaryngoscope.Methods: It was a prospective simulation based trial involving sixteen senior residents as participants. Each resident performed six intubations, three using macintosh laryngoscope and 3 with video laryngoscope each using intubation box, plastic sheet and without any ancillary equipment respectively. Time taken to intubation was recorded as primary outcome. First pass success rate, overall success rate, laryngoscopic view, ease of intubation and any breach in personal protective gear were the secondary outcomes.Results: The mean time to intubation with DL without ancillary equipment, with PS and with IB was [11 (3.2) Vs 18.9 (6.7) Vs 15.94 (6.7), p = 0.0001] sec respectively, while with VL was [15.1 (7.5) Vs 25.2 (13.5) Vs 23.3 (11.4), p = 0.010] sec respectively. Pairwise comparison showed no difference between PS and IB with either DL or VL. There was statistically significant difference in the ease of intubation between DL and VL without any ancillary equipment (p = 0.018), with PS (p < 0.001) and IB (p = 0.001). Overall success rate was 100% in all scenarios.Conclusions: Use of ancillary equipment prolonged the intubation time with both DL and VL, however increased difficulty in maneuvering the tube was faced with VL. This warrants aggressive simulation based training with both the VL and ancillary equipment before using them in clinical practice and testing them in the real world scenario. (C) 2021 Elsevier Ltd. All rights reserved.