Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic

David M. Turer, Cameron H. Good, Benjamin K. Schilling, Robert W. Turer, Nicholas R. Karlowsky, Lucas A. Dvoracek, Heng Ban, Jason S. Chang, J. Peter Rubin

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Study objective: Throughout the coronavirus disease 2019 pandemic, many emergency departments have been using passive protective enclosures (“intubation boxes”) during intubation. The effectiveness of these enclosures remains uncertain. We sought to quantify their ability to contain aerosols using industry standard test protocols. Methods: We tested a commercially available passive protective enclosure representing the most common design and compared this with a modified enclosure that incorporated a vacuum system for active air filtration during simulated intubations and negative-pressure isolation. We evaluated the enclosures by using the same 3 tests air filtration experts use to certify class I biosafety cabinets: visual smoke pattern analysis using neutrally buoyant smoke, aerosol leak testing using a test aerosol that mimics the size of virus-containing particulates, and air velocity measurements. Results: Qualitative evaluation revealed smoke escaping from all passive enclosure openings. Aerosol leak testing demonstrated elevated particle concentrations outside the enclosure during simulated intubations. In contrast, vacuum-filter-equipped enclosures fully contained the visible smoke and test aerosol to standards consistent with class I biosafety cabinet certification. Conclusion: Passive enclosures for intubation failed to contain aerosols, but the addition of a vacuum and active air filtration reduced aerosol spread during simulated intubation and patient isolation.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalAnnals of emergency medicine
Issue number1
StatePublished - Jan 2021
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine


Dive into the research topics of 'Improved Testing and Design of Intubation Boxes During the COVID-19 Pandemic'. Together they form a unique fingerprint.

Cite this