• Tim T H Jen, Vionarica Gusti, Charanjit Badh, Sachin Mehta, Justine Denomme, Shannon Lockhart, Benajir Shams, Beau Klaibert, and Anthony Chau.
• Department of Anesthesia, St. Paul's Hospital/Providence Health Care, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada. timothy929@gmail.com.
• Can J Anaesth. 2021 Sep 1; 68 (9): 1358-1367.

PurposeNovel devices such as the barrier enclosure were developed in hopes of improving provider safety by limiting SARS-CoV-2 transmission during tracheal intubation. Nevertheless, concerns arose regarding a lack of rigorous efficacy and safety data for these devices. We conducted a randomized controlled trial to evaluate the impact of the barrier enclosure on time to tracheal intubation.MethodAfter Research Ethics Board approval, elective surgical patients with normal airway predictors were randomly allocated 1:1 to tracheal intubation with or without a barrier enclosure. The primary outcome was time to tracheal intubation. Secondary outcomes included first-pass success rate, total time of airway manipulation, anesthesiologists' perception of intubation difficulty, likelihood of use in SARS-CoV-2-positive patients, and patients' perception of comfort and acceptability.ResultsThere were 48 participants in the barrier enclosure group and 46 participants in the control group. The mean (standard deviation [SD]) time to tracheal intubation was 62 (29) sec with barrier closure and 53 (27) sec without barrier enclosure (mean difference, 9 sec; 95% confidence interval, - 3 to 20; P = 0.14). Anesthesiologists rated the difficulty of intubation higher with barrier enclosure (mean [SD] visual analogue scale score, 27 [26] mm vs 9 [17] mm; P < 0.001). There were no significant differences in other secondary outcomes.ConclusionIn healthy surgical patients with normal airway predictors, the use of a barrier enclosure during tracheal intubation did not significantly prolong time to intubation or decrease first-pass intubation success. Nevertheless, there was an increase in difficulty of intubation perceived by the anesthesiologists with use of a barrier enclosure.Trial Registrationwww.clinicaltrials.gov (NCT04366141); registered 28 April 2020.© 2021. Canadian Anesthesiologists' Society.

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