The purpose of an intubation box is to contain as much as possible the spread of aerosolized droplets containing Covid-19 viral particles during endotracheal intubation. Based on recent discussions with Anesthesiologists, Intensivists and Surgeons, this is most often happening in regular hospital beds of patients who suddenly decompensate and need urgent intubation. It can also happen in the Emergency Department or Operating Room. This is important because the average OR table is 20" wide, which is too narrow for an effective box with seals around the hand ports. A workaround is to put both armboards on either side of the OR table. A regular hospital bed will allow a box 24" wide without modification.
The design I am offering represents the final iteration of many previous models and designs and I want to thank David Earle MD, Mark Puls MD, Michael Sarup MD, Mary Aaland MD, members of our Anesthesia staff, nursing staff, and my sister Kathy Alexander at J&R Glass who expedited the prototype and got it made in under 24 hrs.
Design considerations are as follows: The box needs to allow placement of the anesthetist's hands through a sealing port at the head of the table. It needs to allow a helper to hold an endotracheal tube or apply cricoid pressure from the right. This assumes that most intubators are right handed. The seals are Applied Medical XL Wound Protectors. Approximate cost $35 each, three will be needed. The box must be easily cleaned.Cleaning instructions came with our box. NO BLEACH or PURE ETHANOL, they will cloud the polymer. It must be strong. The ideal choice is Polycarbonate (Lexan). Acrylic is a poor second choice, it is weaker.
Fabrication tips: It is stronger, cleaner (in looks and easier to clean) if you let a fabricator make this as an inverted "U" shape and then glue on the front and back panel. This is designed to allow a 4'x8' panel as building stock, this way there will be less waste and the cost will be lower. You can make them yourself, however it is hard to glue something this big and keep it true and square. Also your non-professional glue joints will tend to fall apart in rough service and they will not be easy to keep clean. The glued joints (as opposed to the heat-bent joints) should be reinforced with aluminium angle stock. It is a two person job to lift these and put over a patient. Ideally they should be cleaned after use and put on a cart ready for next use. Ideally you will have one everywhere where you will be intubating these patients. This is not something that is going to be carried from code to code all night long without danger of breakage. So you may need one for ICU, ER, and OR.
Reassure the patient that this is a temporary measure and someone will be there to get the tube out when they recover. Cover the patient's side with a loose drape, sheet, or bath blanket to reduce the egress of viral particles in the forward direction.