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Research Letters

Barrier enclosure device during patient preparation for flexible bronchoscopy

Sehgal, Inderpaul Singh; Dhooria, Sahajal; Prasad, Kuruswamy Thurai; Muthu, Valliappan; Aggarwal, Ashutosh Nath; Agarwal, Ritesh

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doi: 10.4103/lungindia.lungindia_482_20
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Sir,

Bronchoscopy is most often performed under local anesthesia with or without conscious sedation.[1] The most troublesome complaint during bronchoscopy is cough. To prevent cough and improve the patient comfort, the upper airways are anesthetized both prior and during the procedure. The airways can be anesthetized either with nebulization of 4% lignocaine solution, with 10% lignocaine spray, or their combination. A recent study found that 10% lignocaine spray was superior to both the nebulization or the combination of nebulization and spray of lignocaine solution.[2] However, spraying of the airways with lignocaine can be associated with aerosol generation and may place the health-care personnel (HCP) at a high risk of infection by the type 2 severe acute respiratory syndrome coronavirus in the current scenario. In this regard, the use of a barrier device can potentially reduce the risk of infection during patient preparation, similar to its use during airway intubation.[3] Herein, we describe one such barrier device that can be used for the safe performance of patient preparation prior to bronchoscopy.

The barrier device is a rectangular box made of transparent plastic material that would cover the patient's head Figure 1. The enclosure device is open from one end through which the patient can position his head for spraying of the airways. The other end is covered and has two oblong openings through which the technician can extend his hands (one to hold the tongue and the other to spray the airways). In a previous report, the dispersion of the aerosol generated during intubation was limited to the inner surface of the barrier device during airway intubation.[34] We believe that the barrier device should be used by the HCP in addition to the personal protective equipment recommended in the AABIP guidelines while anesthetizing the airways before the procedure.[5]

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Figure 1:
The rectangular barrier box with width of 67 cm (A), height of 62 cm (B), and a depth of 40 cm (C). The barrier box has two oblong holes (width, 5 cm [D]; height 8 cm [E]) over the covered end. The oblong holes facilitate the spraying of lignocaine solution during airway preparation before the procedure

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Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Madan K, Mohan A, Agarwal R, Hadda V, Khilnani GC, Guleria R. A survey of flexible bronchoscopy practices in India: The Indian bronchoscopy survey (2017) Lung India. 2018;35:98–107
2. Dhooria S, Chaudhary S, Ram B, Sehgal IS, Muthu V, Prasad KT, et al A randomized trial of nebulized lignocaine, lignocaine spray, or their combination for topical anesthesia during diagnostic flexible bronchoscopy Chest. 2020;157:198–204
3. Sehgal IS, Yaddanapudi LN, Dhooria S, Prasad KT, Puri GD, Muthu V, et al Barrier protection during airway intubation Indian J Crit Care Med. 2020 doi:105005/jp-journals-10071-23460
4. Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier enclosure during endotracheal intubation N Engl J Med. 2020;382:1957–8
5. Wahidi MM, Lamb C, Murgu S, Musani A, Shojaee S, Sachdeva A, et al American Association for Bronchology and Interventional Pulmonology (AABIP) statement on the use of bronchoscopy and respiratory specimen collection in patients with suspected or confirmed COVID-19 infection J Bronchology Interv Pulmonol. 2020 doi: 101097/LBR0000000000000681
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