Different fit factors for the N95 respirator during endotracheal intubation: Comparing video laryngoscopy and direct laryngoscopy

Abstract

Endotracheal tube (ET) intubation is a high-risk procedure for healthcare workers (HCWs) because of exposure to aerosolized disease particles. The effectiveness of (N95) respirators may be decreased by movements due to leakage, especially during ET intubation by direct laryngoscopy (DL). A randomized crossover study was conducted to compare the fit factor of a duckbill-shaped N95 between video laryngoscopy (VL), DL, and ET intubation. Physicians (n34) were enrolled and randomized to each study arm. A quantitative fit test machine measured the fit factor during ET intubation (primary outcome) using VL vs. DL. The lowest fit factor with VL was higher than with DL (168 vs. 88, p0.048). An acceptable fit for an N95 during ET intubation (secondary outcome) with VL was 88.2% compared to 67.6% with DL, albeit the difference was not statistically significant (p0.065). In addition, the angle of head-up and hip bending with VL were lower than with DL (0° vs. 10°, p<0.001, 0° vs. 32°, p <0.001). In conclusion, VL can achieve a superior N95 fit during ET intubation over against DL because the need for physician movement is decreased. HCWs should consider performing ET intubation with VL instead of DL for a more stable N95 fit.