More on Barrier Enclosure during Endotracheal Intubation
Rafael Ortega, Ala Nozari, Robert Canelli
Abstract
More on Barrier Enclosure during Endotracheal IntubationTo the Editor: We think the barrier enclosure described in the letter by Canelli and coworkers (published online in the Journal on April 3) 1 decreases rather than increases safety, especially under emergency conditions.The authors briefly mention that their "aerosol box" restricts hand movement.This restriction is true both for the person performing intubation and for assistants, and it must not be understated.Also, heavy and bulky plexiglass is difficult to carry and position or reposition in emergency situations.These operator conditions are especially worrisome for patients with rapid desaturation, those who are difficult to intubate, or both, since they frequently require quick, additional manipulations and rescue mask ventilation between intubation attempts.The aerosol box also introduces another contaminated device that must be properly handled during use and disinfected between uses to prevent cross-contamination.The box probably redirects droplets and aerosols toward the foot of the bed, and all staff in the room are still exposed to them; thus, the authors' model is inaccurate.We think this technique is unvalidated, does not reduce risk, and probably has unintended safety consequences.