• Dana Singer Harel, Yiqun Lin, Carl Y Lo, Adam Cheng, Jennifer Davidson, Todd P Chang, Clyde Matava, Michael Buyck, Guylaine Neveu, Natasha Collia, Jabeen Fayyaz, Keya Manshadi, Arielle Levy, Stephanie Pellerin, Jonathan Pirie, and International Network for Simulation-based Pediatric Innovation, Research, and Education Aerosol Generating Medical Procedures (INSPIRE AGMP) Investigators.
• Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada.
• Pediatr Crit Care Me. 2024 Oct 1; 25 (10): 918927918-927.

ObjectivesAn aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use.DesignSimulation-based randomized trial, conducted from May to December 2021.SettingFour pediatric simulation centers.SubjectsTeams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box).InterventionsEach team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales.Measurements And Main ResultsA total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92-21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the "low" range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand ( p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales ( p < 0.05).ConclusionsThe use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the "low" range, and there was no significant difference between airway provider and assistant.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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