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BackgroundDisease severity in coronavirus disease 2019 (COVID-19) may be associated with inoculation dose. This has triggered interest in intubation barrier devices to block droplet exposure; however, aerosol protection with these devices is not known. This study hypothesized that barrier devices reduce aerosol outside of the barrier.MethodsAerosol containment in closed, semiclosed, semiopen, and open barrier devices was investigated: (1) "glove box" sealed with gloves and caudal drape, (2) "drape tent" with a drape placed over a frame, (3) "slit box" with armholes and caudal end covered by vinyl slit diaphragms, (4) original "aerosol box," (5) collapsible "interlocking box," (6) "simple drape" over the patient, and (7) "no barrier." Containment was investigated by (1) vapor instillation at manikin's right arm with video-assisted visual evaluation and (2) submicrometer ammonium sulfate aerosol particles ejected through the manikin's mouth with ventilation and coughs. Samples were taken from standardized locations inside and around the barriers using a particle counter and a mass spectrometer. Aerosol evacuation from the devices was measured using standard hospital suction, a surgical smoke evacuator, and a Shop-Vac.ResultsVapor experiments demonstrated leakage via arm holes and edges. Only closed and semiclosed devices and the aerosol box reduced aerosol particle counts (median [25th, 75th percentile]) at the operator's mouth compared to no barrier (combined median 29 [-11, 56], n = 5 vs. 157 [151, 166], n = 5). The other barrier devices provided less reduction in particle counts (133 [128, 137], n = 5). Aerosol evacuation to baseline required 15 min with standard suction and the Shop-Vac and 5 min with a smoke evacuator.ConclusionsBarrier devices may reduce exposure to droplets and aerosol. With meticulous tucking, the glove box and drape tent can retain aerosol during airway management. Devices that are not fully enclosed may direct aerosol toward the laryngoscopist. Aerosol evacuation reduces aerosol content inside fully enclosed devices. Barrier devices must be used in conjunction with body-worn personal protective equipment.Editor’s perspective

Aerosol generation techniques have expanded the utility of aerosol mass spectrometry (AMS) for offline chemical analysis of airborne particles and droplets. However, standard aerosolization techniques require relatively large liquid volumes (e.g., several milliliters) and high sample masses that limit their utility. Here we report the development and characterization of a micronebulization-AMS (MN-AMS) technique that requires as low as 10 µL of sample and can provide quantification of nanogram level of organic and inorganic substances via the usage of an isotopically labeled internal standard (34SO4 2-). Using standard solutions, the detection limits for this technique were determined at 0.189, 0.751, and 2.19 ng for sulfate, nitrate, and organics, respectively. The analytical recoveries for these species are 104%, 87%, and 94%, respectively. This MN-AMS technique was applied successfully to analyzing filter and impactor samples collected using miniature PM samplers deployable on uncrewed atmospheric measurement platforms, such as uncrewed aerial systems (UAS) and tethered balloon systems (TBS). Chemical composition of PM samples collected from a UAS field campaign conducted at the DOE Southern Great Plains (SGP) observatory was characterized. The offline MN-AMS data compared well with the in situ PM composition measured by a co-located Aerosol Chemical Speciation Monitor (ACSM). In addition, the MN-AMS and ion chromatography (IC) agreed well for measurements of sulfate and nitrate concentrations in the PM extracts. This study demonstrates the utility of combining MN-AMS with uncrewed measurement platforms to provide quantitative measurements of ambient PM composition with temporal and spatial resolution. [ABSTRACT FROM AUTHOR]