Comparison of aerosol box intubation with styletted endotracheal tube and intubation over bougie: A randomized controlled trial.

BACKGROUND AND AIMS: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is an infectious disease. The use of video laryngoscopes is recommended for intubation of patients with COVID-19. But in resource-poor countries, it is rare to have video laryngoscopes available. In this trial, we have compared the ease of oral intubation by direct laryngoscopy with styletted endotracheal tube and intubation over the bougie, with the use of the aerosol box. The secondary objectives were comparison of the incidence of airway loss, attempts taken to intubate, time for intubation and hemodynamic changes.

MATERIAL AND METHODS: 80 non-coronavirus infected patients coming for an elective procedure under general anesthesia were recruited in this randomized control trial. Participants were assigned into groups S and B using a computer-generated random sequence of numbers by closed envelope technique. In both groups, aerosol box was used. In Group S, participants were intubated by direct laryngoscopy with a styletted endotracheal tube and in group B, after direct laryngoscopy, the endotracheal tube was railroaded over the bougie.

RESULTS: Ease of endotracheal intubation was good (67.5%% vs. 45%), satisfactory (32.5%% vs. 37.5%), and poor (0% vs. 17.5%) in group S and B respectively ( P < 0.011). The attempts required for intubation were similar in both groups. The time for intubation was significantly less in group S than B (23 vs. 55 s).

CONCLUSION: The use of a styletted endotracheal tube made intubation easier and faster than tracheal intubation with bougie when the aerosol box was used in patients without known or predicted difficult airway and significant medical comorbidities.