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Zhang MX, Lilien TA, van Etten-Jamaludin FS, Fraenkel CJ, Bonn D, Vlaar APJ, Löndahl J, Klompas M, Bem RA. Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337258. [PMID: 37819660 PMCID: PMC10568354 DOI: 10.1001/jamanetworkopen.2023.37258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. Objective To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. Data Sources A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. Study Selection Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. Data Extraction and Synthesis Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. Main Outcomes and Measures The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. Results Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. Conclusions and Relevance This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.
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Affiliation(s)
- Madeline X. Zhang
- Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs A. Lilien
- Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Carl-Johan Fraenkel
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Daniel Bonn
- Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jakob Löndahl
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Reinout A. Bem
- Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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Lee LYY, Landry SA, Jamriska M, Subedi D, Joosten SA, Barr JJ, Brown R, Kevin K, Schofield R, Monty J, Subbarao K, McGain F. Quantifying the reduction of airborne infectious virus load using a ventilated patient hood. J Hosp Infect 2023; 136:110-117. [PMID: 37105259 PMCID: PMC10125916 DOI: 10.1016/j.jhin.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Healthcare workers treating SARS-CoV-2 patients are at risk of infection by respiratory exposure to patient-emitted, virus-laden aerosols. Source control devices such as ventilated patient isolation hoods have been shown to limit the dissemination of non-infectious airborne particles in laboratory tests, but data on their performance in mitigating the airborne transmission risk of infectious viruses are lacking. AIM We used an infectious airborne virus to quantify the ability of a ventilated hood to reduce infectious virus exposure in indoor environments. METHODS We nebulized 109 plaque forming units (pfu) of bacteriophage PhiX174 virus into a ∼30-m3 room when the hood was active or inactive. The airborne concentration of infectious virus was measured by BioSpot-VIVAS and settle plates using plaque assay quantification on the bacterial host Escherichia coli C. The airborne particle number concentration (PNC) was also monitored continuously using an optical particle sizer. FINDINGS The median airborne viral concentration in the room reached 1.41 × 105 pfu/m3 with the hood inactive. When active, the hood reduced infectious virus concentration in air samples by 374-fold. The deposition of infectious virus on the surface of settle plates was reduced by 87-fold. This was associated with a 109-fold reduction in total airborne particle number escape rate. CONCLUSION A personal ventilation hood significantly reduced airborne particle escape, considerably lowering infectious virus contamination in an indoor environment. Our findings support the further development of source control devices to mitigate nosocomial infection risk among healthcare workers exposed to airborne viruses in clinical settings.
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Affiliation(s)
- L Y Y Lee
- Department of Microbiology and Immunology, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - S A Landry
- Department of Physiology, School of Biomedical Sciences & Biomedical Discovery Institute, Monash University, Melbourne, VIC, Australia
| | - M Jamriska
- Defence Science and Technology Group, Fishermans Bend, VIC, Australia
| | - D Subedi
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - S A Joosten
- School of Biological Sciences, Monash University, Clayton, VIC, Australia; Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, VIC, Australia; School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Monash Partners, Epworth, Victoria, VIC, Australia
| | - J J Barr
- School of Biological Sciences, Monash University, Clayton, VIC, Australia
| | - R Brown
- Defence Science and Technology Group, Fishermans Bend, VIC, Australia
| | - K Kevin
- School of Mechanical Engineering, University of Melbourne, Melbourne VIC, Australia
| | - R Schofield
- School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - J Monty
- School of Mechanical Engineering, University of Melbourne, Melbourne VIC, Australia
| | - K Subbarao
- Department of Microbiology and Immunology, University of Melbourne, At the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; WHO Collaborating Centre for Reference and Research on Influenza, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - F McGain
- Departments of Anaesthesia and Intensive Care, Western Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
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Crimi C, Murphy P, Patout M, Sayas J, Winck JC. Lessons from COVID-19 in the management of acute respiratory failure. Breathe (Sheff) 2023; 19:230035. [PMID: 37378059 PMCID: PMC10292773 DOI: 10.1183/20734735.0035-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 06/29/2023] Open
Abstract
Accumulated evidence supports the efficacy of noninvasive respiratory support therapies in coronavirus disease 2019 (COVID-19)-related acute hypoxaemic respiratory failure, alleviating admissions to intensive care units. Noninvasive respiratory support strategies, including high-flow oxygen therapy, continuous positive airway pressure via mask or helmet and noninvasive ventilation, can be alternatives that may avoid the need for invasive ventilation. Alternating different noninvasive respiratory support therapies and introducing complementary interventions, like self-proning, may improve outcomes. Proper monitoring is warranted to ensure the efficacy of the techniques and to avoid complications while supporting transfer to the intensive care unit. This article reviews the latest evidence on noninvasive respiratory support therapies in COVID-19-related acute hypoxaemic respiratory failure.
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Affiliation(s)
- Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Respiratory Medicine Unit, Policlinico “G. Rodolico-San Marco” University Hospital, Catania, Italy
| | - Patrick Murphy
- Lane Fox Respiratory Service, Guy's and St Thomas’ Hospitals NHS Trust, London, UK
- Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Maxime Patout
- Service des Pathologies du Sommeil (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, INSERM, Paris, France
| | - Javier Sayas
- Pulmonology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina Universidad Complutense de Madrid, Madrid, Spain
| | - Joao Carlos Winck
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Centro De Reabilitação Do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova De Gaia, Portugal
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Waring MS, Lo LJ, Kohanski MA, Kahle E, Marcus IM, Smith H, Spiller KL, Walker SL. Design and quantitative evaluation of 'Aerosol Bio-Containment Device (ABCD)' for reducing aerosol exposure during infectious aerosol-generating events. PLoS One 2023; 18:e0272716. [PMID: 36608021 PMCID: PMC9821519 DOI: 10.1371/journal.pone.0272716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/25/2022] [Indexed: 01/07/2023] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic renewed interest in infectious aerosols and reducing risk of airborne respiratory pathogen transmission, prompting development of devices to protect healthcare workers during airway procedures. However, there are no standard methods for assessing the efficacy of particle containment with these protective devices. We designed and built an aerosol bio-containment device (ABCD) to contain and remove aerosol via an external suction system and tested the aerosol containment of the device in an environmental chamber using a novel, quantitative assessment method. The ABCD exhibited a strong ability to control aerosol exposure in experimental and computational fluid dynamic (CFD) simulated scenarios with appropriate suction use and maintenance of device seals. Using a log-risk-reduction framework, we assessed device containment efficacy and showed that, when combined with other protective equipment, the ABCD can significantly reduce airborne clinical exposure. We propose this type of quantitative analysis serves as a basis for rating efficacy of aerosol protective enclosures.
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Affiliation(s)
- Michael S. Waring
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
- * E-mail:
| | - L. James Lo
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
| | - Michael A. Kohanski
- Division of Rhinology, Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Elizabeth Kahle
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States of America
| | - Ian M. Marcus
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
| | - Heather Smith
- Life Sciences Department, Riverside City College, Riverside, CA, United States of America
| | - Kara L. Spiller
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, United States of America
| | - Sharon L. Walker
- Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, United States of America
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PAGNUCCI NICOLA, FORNILI MARCO, PRADAL MARILENA, UCCELLI FRANCESCO, BOVONE ALESSANDRA, MEINI MICHELE, SCATENI MONICA, BAGLIETTO LAURA, FORFORI FRANCESCO. Reorganization of Intensive Care Units for the COVID-19 pandemic: effects on nursing sensitive outcomes. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E383-E390. [PMID: 36415295 PMCID: PMC9648556 DOI: 10.15167/2421-4248/jpmh2022.63.3.2557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Since the first months of 2020 COVID-19 patients who were seriously ill due to the development of ARDS, required admission to the intensive care unit to ensure potentially life-saving mechanical ventilation and support for vital functions. To cope with this emergency, an extremely rapid reorganization of premises, services and staff, to dedicate an entire intensive care unit exclusively to SARS-CoV-2 patients and increasing the number of beds was essential. The aim of the study was to evaluate the effects of reorganization of the COVID-19 intensive care unit in terms of nursing sensitive outcomes. METHODS a retrospective observational study was conducted to compare nursing sensitive outcomes between pre-COVID period and COVID period. RESULTS Falls (0.0 and 0.4%, respectively), physical restraint (1.8 and 1.1%, respectively), and pressure ulcers (8.0 and 3.0%, respectively) were similar in the COVID and in the pre-COVID group. After adjusting for gender, age, BMI, and number of comorbidities, the incidence of bloodstream infections was significantly higher in the COVID group than in the pre-COVID group. There were no statistically significant differences in the incidence between the two groups regarding other evaluated outcomes. CONCLUSION The selected nursing sensitive outcomes maintained similar values in the pre-COVID and COVID patient groups. Healthcare-related infections rate must be considered an important alarm signal of quality of nursing care especially in conditions of excessive workload, stress and the presence of less experienced staff increase.
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Affiliation(s)
- NICOLA PAGNUCCI
- University of Pisa, Department of Clinical and Experimental Medicine
| | - MARCO FORNILI
- University of Pisa, Department of Clinical and Experimental Medicine
| | | | | | | | | | | | - LAURA BAGLIETTO
- University of Pisa, Department of Clinical and Experimental Medicine
| | - FRANCESCO FORFORI
- University of Pisa, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine
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Patel J, McGain F, Bhatelia T, Wang S, Sun B, Monty J, Pareek V. Vented Individual Patient (VIP) Hoods for the Control of Infectious Airborne Diseases in Healthcare Facilities. ENGINEERING (BEIJING, CHINA) 2022; 15:126-132. [PMID: 35721872 PMCID: PMC9197795 DOI: 10.1016/j.eng.2020.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/28/2020] [Accepted: 12/17/2020] [Indexed: 05/13/2023]
Abstract
By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers (HCWs), vented individual patient (VIP) hoods, a form of local exhaust ventilation (LEV), offer a new approach to reduce hospital-acquired infection (HAI). Results from recent studies have demonstrated that, for typical patient-emitted aerosols, VIP hoods provide protection at least equivalent to that of an N95 mask. Unlike a mask, hood performance can be easily monitored and HCWs can be alerted to failure by alarms. The appropriate use of these relatively simple devices could both reduce the reliance on personal protective equipment (PPE) for infection control and provide a low-cost and energy-efficient form of protection for hospitals and clinics. Although the development and deployment of VIP hoods has been accelerated by the coronavirus disease 2019 (COVID-19) pandemic, these devices are currently an immature technology. In this review, we describe the state of the art of VIP hoods and identify aspects in need of further development, both in terms of device design and the protocols associated with their use. The broader concept of individual patient hoods has the potential to be expanded beyond ventilation to the provision of clean conditions for individual patients and personalized control over other environmental factors such as temperature and humidity.
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Affiliation(s)
- J Patel
- CSIRO Energy, Melbourne, VIC 3169, Australia
| | - F McGain
- Western Health, Melbourne, VIC 3021, Australia
- School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - T Bhatelia
- The Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Perth, WA 6102, Australia
| | - S Wang
- Department of Mechanical Engineering, City University of Hong Kong, Hong Kong 999077, China
| | - B Sun
- The Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Perth, WA 6102, Australia
| | - J Monty
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - V Pareek
- The Western Australian School of Mines: Minerals, Energy and Chemical Engineering, Curtin University, Perth, WA 6102, Australia
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7
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Roth BS, Moschella P, Mousavi ES, LeMatty AS, Falconer RJ, Ashley ND, Mohammadi Nafchi A, Gaafary C, DesJardins JD. Development and efficacy testing of a portable negative pressure enclosure for airborne infection containment. J Am Coll Emerg Physicians Open 2022; 3:e12656. [PMID: 35112100 PMCID: PMC8783378 DOI: 10.1002/emp2.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/04/2021] [Accepted: 12/29/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To overcome the shortage of personal protective equipment and airborne infection isolation rooms (AIIRs) in the COVID-19 pandemic, a collaborative team of research engineers and clinical physicians worked to build a novel negative pressure environment in the hopes of improving healthcare worker and patient safety. The team then sought to test the device's efficacy in generating and maintaining negative pressure. The goal proved prescient as the US Food and Drug Administration (FDA) later recommended that all barrier devices use negative pressure. METHODS Initially, engineers observed simulations of various aerosol- and droplet-generating procedures using hospital beds and stretchers to determine the optimal working dimensions of the containment device. Several prototypes were made based on these dimensions which were combined with filters and various flow-generating devices. Then, the airflow generated and the pressure differential within the device during simulated patient care were measured, specifically assessing its ability to create a negative pressure environment consistent with standards published by the Centers for Disease Control and Prevention (CDC). RESULTS The portable fans were unable to generate any airflow and were dropped from further testing. The vacuums tested were all able to generate a negative pressure environment with the magnitude of pressure differential increasing with the vacuum horsepower. Only the 3.5-horsepower Shop-Vac, however, generated a -3.0 pascal (Pa) pressure gradient, exceeding the CDC-recommended minimum of -2.5 Pa for AIIRs. CONCLUSION A collaborative team of physicians and engineers demonstrated the efficacy of a prototype portable negative pressure environment, surpassing the negative pressure differential recommended by the CDC.
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Affiliation(s)
- Benjamin S. Roth
- Prisma Health UpstateUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
| | - Phillip Moschella
- Prisma Health UpstateUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
| | - Ehsan S. Mousavi
- Department of Construction Science and ManagementClemson UniversityClemsonSouth CarolinaUSA
| | - Amanda S. LeMatty
- Department of BioengineeringClemson UniversityClemsonSouth CarolinaUSA
| | | | - Noah D. Ashley
- Department of BioengineeringClemson UniversityClemsonSouth CarolinaUSA
| | - Ali Mohammadi Nafchi
- Department of Construction Science and ManagementClemson UniversityClemsonSouth CarolinaUSA
| | - Chris Gaafary
- Prisma Health UpstateUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
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Mousavi ES, Mohammadi Nafchi A, DesJardins JD, LeMatty AS, Falconer RJ, Ashley ND, Roth BS, Moschella P. Design and in-vitro testing of a portable patient isolation chamber for bedside aerosol containment and filtration. BUILDING AND ENVIRONMENT 2022; 207:108467. [PMID: 34720358 PMCID: PMC8542519 DOI: 10.1016/j.buildenv.2021.108467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
The emergence of the SARS-CoV-2 pandemic has imposed a multitude of complications on healthcare facilities. Healthcare professionals had to develop creative solutions to deal with resource shortages and isolation spaces when caring for COVID positive patients. Among many other solutions, facilities have utilized engineering strategies to mitigate the spread of viral contamination within the hospital environment. One of the standard solutions has been the use of whole room negative pressurization (WRNP) to turn a general patient room into an infection isolation space. However, this has not always been easy due to many limitations, such as direct access to the outdoors and the availability of WRNP units. In operating rooms where a patient is likely to go through aerosol-generating procedures, other solutions must be considered because most operating rooms use positive pressure ventilation to maintain sterility. The research team has designed, built, and tested a Covering for Operations during Viral Emergency Response (COVER), a low-cost, portable isolation chamber that fits over a patient's torso on a hospital bed to contain and remove the pathogenic agents at the source (i.e., patient's mouth and nose). This study tests the performance of the COVER system under various design and performance scenarios using particle tracing techniques and compares its efficiency with WRNP units. The results show that COVER can dramatically reduce the concentration of particles within the room, while WRNP is only effective in preventing the room-induced particles from migrating to adjacent spaces.
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Affiliation(s)
- Ehsan S Mousavi
- Neiri Family Department of Construction Science and Management, Clemson University, Clemson, SC, 29634, USA
| | - Ali Mohammadi Nafchi
- Neiri Family Department of Construction Science and Management, Clemson University, Clemson, SC, 29634, USA
| | - John D DesJardins
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Amanda S LeMatty
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Robert J Falconer
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Noah D Ashley
- Department of Bioengineering, Clemson University, Clemson, SC, 29634, USA
| | - Benjamin S Roth
- Prisma Health Upstate, University of South Carolina School of Medicine of Greenville, Greenville, SC, 29611, USA
| | - Phillip Moschella
- Prisma Health Upstate, University of South Carolina School of Medicine of Greenville, Greenville, SC, 29611, USA
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Kodumayil SA, Kodumayil A, Thomas SA, Pathan SA, Bhutta ZA, Qureshi I, Azad A, Harris TR, Thomas SH. Q-DEPICT: Qatar Determining Emergency Physician Incidence of COVID-Positive Testing. Qatar Med J 2021; 2021:44. [PMID: 34660215 PMCID: PMC8501270 DOI: 10.5339/qmj.2021.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Despite protective measures such as personal protective equipment (PPE) and a COVID airway management program (CAMP), some emergency physicians will inevitably test positive for COVID. We aim to develop a model predicting weekly numbers of emergency physician COVID converters to aid operations planning. The data were obtained from the electronic medical record (EMR) used throughout the national healthcare system. Hamad Medical Corporation's internal emergency medicine workforce data were used as a source of information on emergency physician COVID conversion and numbers of emergency physicians completing CAMP training. The study period included the spring and summer months of 2020 and started on March 7 and ran for 21 whole weeks through July 31. Data were extracted from the system's EMR database into a spreadsheet (Excel, Microsoft, Redmond, USA). The statistical software used for all analyses and plots was Stata (version 16.1 MP, StataCorp, College Station, USA). All data definitions were made a priori. A total of 35 of 250 emergency physicians (14.0%, 95% CI 9.9%–19.9%) converted to a positive real-time reverse transcriptase-polymerase chain reaction (PCR) during the study's 21-week period. Of these. only two were hospitalized for having respiratory-only disease, and none required respiratory support. Both were discharged within a week of admission. The weekly number of newly COVID-positive emergency physicians was zero and was seen in eight of 21 (38.1%) weeks. The peak weekly counts of six emergency physicians with new COVID-positive were seen in week 14. The mean weekly number of newly COVID-positive emergency physicians was 1.7 ± 1.9, and the median was 1 (IQR, 0 to 3). This study demonstrates that in the State of Qatar's Emergency Department (ED) system, knowing only four parameters allows the reliable prediction of the number of emergency physicians likely to convert COVID PCR tests within the next week. The results also suggest that attention to the details of minimizing endotracheal intubation (ETI) risk can eliminate the expected finding of the association between ETI numbers and emergency physician COVID numbers.
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Affiliation(s)
| | - Ashid Kodumayil
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Sarah A Thomas
- BSc Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | | | | | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Aftab Azad
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Tim R Harris
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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A prospective clinical evaluation of a patient isolation hood during the COVID-19 pandemic. Aust Crit Care 2021; 35:28-33. [PMID: 34144863 PMCID: PMC8112290 DOI: 10.1016/j.aucc.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/20/2021] [Accepted: 05/01/2021] [Indexed: 01/01/2023] Open
Abstract
Background Healthcare workers (HCWs) have frequently become infected with severe acute respiratory syndrome coronavirus 2 whilst treating patients with coronavirus disease 2019 (COVID-19). A variety of novel devices have been proposed to reduce COVID-19 cross-contamination. Objectives The aim of the study was (i) to test whether patients and HCWs thought that a novel patient isolation hood was safe and comfortable and (ii) to obtain COVID-19 infection data of hospital HCWs. Methods This is a prospective cohort study of 20 patients, entailing HCW/patient questionnaires and safety aspects of prototype isolation hoods. COVID-19 data of HCWs were prospectively collected. Assessment of the hood's safety and practicality and adverse event reporting was carried out. Outcome measures The outcome measures are as follows: questionnaire responses, adverse event reporting, rates of infections in HCWs during the study period (20/6/2020 to 21/7/2020), and COVID-19 infections in HCWs reported until the last recorded diagnosis of COVID-19 in HCWs (20/6/2020 to 27/9/2020). Results Of the 64 eligible individual HCW surveys, 60 surveys were overall favourable (>75% questions answered in favour of the isolation hood). HCWs were unanimous in perceiving the hood as safe (60/60), preferring its use (56/56), and understanding its potential COVID-19 cross-contamination minimisation (60/60). All eight patients who completed the questionnaire thought the isolation hood helped prevent COVID-19 cross infection and was safe and comfortable. There were no reported patient safety adverse events. The COVID-19 attack rate from 20/6/2020 to 27/9/2020 among registered nurses was as follows: intensive care units (ICUs), 2.2% (3/138); geriatric wards, 13.2% (26/197); and COVID-19 wards, 18.3% (32/175). The COVID-19 attack rate among medical staff was as follows: junior staff, 2.1% (24/932); senior staff, 0.7% (4/607); aged care/rehabilitation, 6.7% (2/30); and all ICU medical staff, 8.6% (3/35). Conclusions The isolation hood was preferred to standard care by HCWs and well tolerated by patients, and after the study, isolation hoods became part of standard ICU therapy. There was an association between being an ICU nurse and a low COVID-19 infection rate (no causality implied). ICU HCWs feel safer when treating patients with COVID-19 using an isolation hood.
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Gulla KM, Kabra SK, Lodha R. Feasibility of Pediatric Non-Invasive Respiratory Support in Low- and Middle-Income Countries. Indian Pediatr 2021. [PMID: 33941707 PMCID: PMC8639409 DOI: 10.1007/s13312-021-2377-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Non-Invasive respiratory support can be viewed as mechanical respiratory support without endotracheal intubation and it includes continuous positive airway pressure, bi-level positive airway pressure, high flow nasal cannula, and non-invasive positive pressure ventilation. Over past few years, non-invasive respiratory support is getting more popular across pediatric intensive care units for acute respiratory failure as well as for long-term ventilation support at home. It reduces the need for invasive mechanical ventilation, decreases the risk of nosocomial pneumonia as well as mortality in selected pediatric and adult population. Unfortunately, majority of available studies on non-invasive respiratory support have been conducted in high-income countries, which are different from low-and middle-income countries (LMICs) in terms of resources, manpower, and the disease profile. Hence, we need to consider disease profile, severity at hospital presentation, availability of age-appropriate equipment, ability of healthcare professionals to manage patients on non-invasive respiratory support, and cost-benefit ratio. In view of the relatively high cost of equipment, there is a need to innovate to develop indigenous kits/devices with available resources in LMICs to reduce the cost and potentially benefit health system. In this review, we highlight the role of non-invasive respiratory support in different clinical conditions, practical problems encountered in LMICs setting, and few indigenous techniques to provide non-invasive respiratory support.
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12
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August A, Bolhouse M, Rice B, Wall JK. Negative pressure patient isolation device to enable non-invasive respiratory support for COVID-19 and beyond. BMJ INNOVATIONS 2021; 7:292-296. [PMID: 37556246 PMCID: PMC7736963 DOI: 10.1136/bmjinnov-2020-000551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Auriel August
- General
Surgery, Stanford Medicine, Stanford, California, USA
- Biodesign,
Stanford University, Palo
Alto, California,
USA
| | | | - Brian Rice
- Emergency
Medicine, Stanford Medicine, Stanford, California, USA
| | - James Kennedy Wall
- Pediatric
Surgery, Stanford Children's Health,
Palo Alto, California, USA
- Bioengineering, Stanford University, Palo Alto, California, USA
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13
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Chalmers JD, Crichton ML, Goeminne PC, Cao B, Humbert M, Shteinberg M, Antoniou KM, Ulrik CS, Parks H, Wang C, Vandendriessche T, Qu J, Stolz D, Brightling C, Welte T, Aliberti S, Simonds AK, Tonia T, Roche N. Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline. Eur Respir J 2021; 57:2100048. [PMID: 33692120 PMCID: PMC7947358 DOI: 10.1183/13993003.00048-2021] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hospitalised patients with coronavirus disease 2019 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require noninvasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes. METHODS A task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this "living guideline" using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations. RESULTS Based on the available evidence at the time of guideline development (20 February, 2021), the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for interleukin (IL)-6 receptor antagonist monoclonal antibody treatment and high-flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine combined with azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made. CONCLUSION The evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.
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Affiliation(s)
- James D Chalmers
- School of Medicine, University of Dundee, Dundee, UK
- J.D. Chalmers and N. Roche are task force co-chairs
| | | | - Pieter C Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Saclay; Inserm UMR_S 999, Le Kremlin Bicêtre, France
| | - Michal Shteinberg
- Pulmonology institute and CF Center, Carmel Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre Hospital, Hvidovre, Denmark
| | | | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | | | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
- Clinic of Respiratory Medicine, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy
| | - Anita K Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield Hospital, Guys and St Thomas NHS Foundation Trust, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
- J.D. Chalmers and N. Roche are task force co-chairs
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14
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Feldman O, Samuel N, Kvatinsky N, Idelman R, Diamand R, Shavit I. Endotracheal intubation of COVID-19 patients by paramedics using a box barrier: A randomized crossover manikin study. PLoS One 2021; 16:e0248383. [PMID: 33788837 PMCID: PMC8011788 DOI: 10.1371/journal.pone.0248383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/25/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In the prehospital setting, endotracheal intubation (ETI) may be required to secure the coronavirus disease 2019 (COVID-19) patient airway. It has been suggested that the use of a protective barrier can reduce possible aerosol delivery from patients to clinicians during ETI. We sought to assess the performance of ETI by paramedics wearing personal protective equipment with and without the use of a box barrier. METHODS A randomized, crossover simulation study was performed in a simulation laboratory. Study participants were 18 paramedics actively working in the clinical environment. Participants' performance of ETI via direct laryngoscopy (DL) with and without the use of a box barrier was assessed. The sequence of intubation was randomized to either BoxDL-first or DL-first. The primary outcome was the success rate of ETI on first-attempt. The secondary and tertiary outcomes were ETI success rates on three attempts and total intubation time, respectively. RESULTS There were no differences between the DL group and the BoxDL group in one-attempt success rates (14/18 vs 12/18; P = 0.754), and in overall success rates (16/18 vs 14/18; P = 0.682). The mean (standard deviation) of the total intubation times for the DL group and the BoxDL group were 27.3 (19.7) seconds and 36.8 (26.2) seconds, respectively (P < 0.015). CONCLUSIONS The findings of this pilot study suggest that paramedics wearing personal protective equipment can successfully perform ETI using a barrier box, but the intubation time may be prolonged. The applicability of these findings to the care of COVID-19 patients remain to be investigated.
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Affiliation(s)
- Oren Feldman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Nir Samuel
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
- Department of Neurobiology, Weizmann Institute of Science, Rehovot, Israel
| | - Noa Kvatinsky
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Ravit Idelman
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Raz Diamand
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
| | - Itai Shavit
- Pediatric Emergency Department, Rambam Health Care Campus, Haifa, Israel
- * E-mail:
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15
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Bartier S, La Croix C, Evrard D, Hervochon R, Laccourreye O, Gasne C, Excoffier A, Tanaka L, Barry B, Coste A, Tankere F, Kania R, Nevoux J. Tracheostomies after SARS-CoV-2 intubation, performed by academic otorhinolaryngologists in the Paris area of France: Preliminary results. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:443-449. [PMID: 33707069 PMCID: PMC7931693 DOI: 10.1016/j.anorl.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective To analyse tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020. Material and methods A multicentre retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the COVID-19 status of the otorhinolaryngologists. Secondary goals were to analyse tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status. Results Tracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases, respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases, respectively. None of the operators developed symptoms consistent with COVID-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (P = 0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20 ± 12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions. Conclusion The main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centres, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.
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Affiliation(s)
- S Bartier
- Service ORL, Centre hospitalier intercommunal de Créteil, Université Paris Est, 40, avenue de Verdun, 94000 Créteil, France.
| | - C La Croix
- Service ORL, AP-HP, Hôpital Cochin AP-HP, Université Paris centre, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France
| | - D Evrard
- Service ORL, Hôpital Bichat, AP-HP, Université Paris centre, 46, rue Henri-Huchard, 75018 Paris, France
| | - R Hervochon
- Service ORL, AP-HP, Hôpital La Pitié-Salpétrière, Université Paris Sorbonne, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - O Laccourreye
- Service ORL, AP-HP, HEGP, Université Paris Centre, 20-40, rue Leblanc, 75015 Paris, France
| | - C Gasne
- Service ORL, AP-HP, Hôpital Tenon, AP-HP, Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France
| | - A Excoffier
- Service ORL, AP-HP, Hôpital Tenon, AP-HP, Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France
| | - L Tanaka
- Service ORL, AP-HP, Hôpital Bicêtre, Université Paris Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - B Barry
- Service ORL, Hôpital Bichat, AP-HP, Université Paris centre, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Coste
- Service ORL, Centre hospitalier intercommunal de Créteil, Université Paris Est, 40, avenue de Verdun, 94000 Créteil, France
| | - F Tankere
- Service ORL, AP-HP, Hôpital La Pitié-Salpétrière, Université Paris Sorbonne, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Kania
- Service ORL, AP-HP, Hôpital Lariboisière, Université Paris Nord, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J Nevoux
- Service ORL, AP-HP, Hôpital Bicêtre, Université Paris Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
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16
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Patout M, Fresnel E, Lujan M, Rabec C, Carlucci A, Razakamanantsoa L, Kerfourn A, Nunes H, Tandjaoui-Lambiotte Y, Cuvelier A, Muir JF, Lalmoda C, Langevin B, Sayas J, Gonzalez-Bermejo J, Janssens JP. Recommended Approaches to Minimize Aerosol Dispersion of SARS-CoV-2 During Noninvasive Ventilatory Support Can Cause Ventilator Performance Deterioration: A Benchmark Comparative Study. Chest 2021; 160:175-186. [PMID: 33667491 PMCID: PMC7921720 DOI: 10.1016/j.chest.2021.02.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 01/07/2023] Open
Abstract
Background SARS-CoV-2 aerosolization during noninvasive positive-pressure ventilation may endanger health care professionals. Various circuit setups have been described to reduce virus aerosolization. However, these setups may alter ventilator performance. Research Question What are the consequences of the various suggested circuit setups on ventilator efficacy during CPAP and noninvasive ventilation (NIV)? Study Design and Methods Eight circuit setups were evaluated on a bench test model that consisted of a three-dimensional printed head and an artificial lung. Setups included a dual-limb circuit with an oronasal mask, a dual-limb circuit with a helmet interface, a single-limb circuit with a passive exhalation valve, three single-limb circuits with custom-made additional leaks, and two single-limb circuits with active exhalation valves. All setups were evaluated during NIV and CPAP. The following variables were recorded: the inspiratory flow preceding triggering of the ventilator, the inspiratory effort required to trigger the ventilator, the triggering delay, the maximal inspiratory pressure delivered by the ventilator, the tidal volume generated to the artificial lung, the total work of breathing, and the pressure-time product needed to trigger the ventilator. Results With NIV, the type of circuit setup had a significant impact on inspiratory flow preceding triggering of the ventilator (P < .0001), the inspiratory effort required to trigger the ventilator (P < .0001), the triggering delay (P < .0001), the maximal inspiratory pressure (P < .0001), the tidal volume (P = .0008), the work of breathing (P < .0001), and the pressure-time product needed to trigger the ventilator (P < .0001). Similar differences and consequences were seen with CPAP as well as with the addition of bacterial filters. Best performance was achieved with a dual-limb circuit with an oronasal mask. Worst performance was achieved with a dual-limb circuit with a helmet interface. Interpretation Ventilator performance is significantly impacted by the circuit setup. A dual-limb circuit with oronasal mask should be used preferentially.
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Affiliation(s)
- Maxime Patout
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service des Pathologies du Sommeil (Département R3S), F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; Respiratory Department, Avicenne Hospital, AP-HP, Bobigny, France; Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.
| | - Emeline Fresnel
- Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France; Kernel Biomedical, Bois-Guillaume, France
| | - Manuel Lujan
- Pneumology Department, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, University Hospital Dijon, Dijon, France; Fédération ANTADIR, Paris, France
| | - Annalisa Carlucci
- Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Pavia, Italy; Department of Medicine, University of Insubria Varese, Como, Italy
| | - Léa Razakamanantsoa
- Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Adrien Kerfourn
- Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France; Kernel Biomedical, Bois-Guillaume, France
| | - Hilario Nunes
- Respiratory Department, Avicenne Hospital, AP-HP, Bobigny, France; INSERM U1272, "Hypoxia and the Lung", Paris 13 University, Bobigny, France
| | - Yacine Tandjaoui-Lambiotte
- INSERM U1272, "Hypoxia and the Lung", Paris 13 University, Bobigny, France; Intensive Care Unit, Avicenne Hospital, AP-HP, Bobigny, France
| | | | - Jean-François Muir
- Normandie University, UNIRouen, EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France; Fédération ANTADIR, Paris, France
| | - Cristina Lalmoda
- Pneumology Department, Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Bruno Langevin
- Réanimation, Pôle Soins Aigus, Centre Hospitalier Alès, Alès, France
| | - Javier Sayas
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jesus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), F-75013 Paris, France
| | - Jean-Paul Janssens
- Division of Pulmonary Diseases, Geneva University Hospitals (HUG), Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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17
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Gulla KM, Kabra SK, Lodha R. Feasibility of Pediatric Non-Invasive Respiratory Support in Low- and Middle-Income Countries. Indian Pediatr 2021; 58:1077-1084. [PMID: 33941707 PMCID: PMC8639409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Non-Invasive respiratory support can be viewed as mechanical respiratory support without endotracheal intubation and it includes continuous positive airway pressure, bi-level positive airway pressure, high flow nasal cannula, and non-invasive positive pressure ventilation. Over past few years, non-invasive respiratory support is getting more popular across pediatric intensive care units for acute respiratory failure as well as for long-term ventilation support at home. It reduces the need for invasive mechanical ventilation, decreases the risk of nosocomial pneumonia as well as mortality in selected pediatric and adult population. Unfortunately, majority of available studies on non-invasive respiratory support have been conducted in high-income countries, which are different from low- and middle-income countries (LMICs) in terms of resources, manpower, and the disease profile. Hence, we need to consider disease profile, severity at hospital presentation, availability of age-appropriate equipment, ability of healthcare professionals to manage patients on non-invasive respiratory support, and cost-benefit ratio. In view of the relatively high cost of equipment, there is a need to innovate to develop indigenous kits/ devices with available resources in LMICs to reduce the cost and potentially benefit health system. In this review, we highlight the role of non-invasive respiratory support in different clinical conditions, practical problems encountered in LMICs setting, and few indigenous techniques to provide non-invasive respiratory support.
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Affiliation(s)
- Krishna Mohan Gulla
- grid.413618.90000 0004 1767 6103Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, New Delhi, 110 029 India
| | - Sushil Kumar Kabra
- grid.413618.90000 0004 1767 6103Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, New Delhi, 110 029 India
| | - Rakesh Lodha
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi. Correspondence to: Dr Rakesh Lodha, Professor, Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, New Delhi,110 029.
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18
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Price C, Ben-Yakov M, Choi J, Orchanian-Cheff A, Tawadrous D. Barrier enclosure use during aerosol-generating medical procedures: A scoping review. Am J Emerg Med 2020; 41:209-218. [PMID: 33189515 PMCID: PMC7837026 DOI: 10.1016/j.ajem.2020.10.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Barrier enclosure devices were introduced to protect against infectious disease transmission during aerosol generating medical procedures (AGMP). Recent discussion in the medical community has led to new designs and adoption despite limited evidence. A scoping review was conducted to characterize devices being used and their performance. METHODS We conducted a scoping review of formal databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus), grey literature, and hand-searched relevant journals. Forward and reverse citation searching was completed on included articles. Article/full-text screening and data extraction was performed by two independent reviewers. Studies were categorized by publication type, device category, intended medical use, and outcomes (efficacy - ability to contain particles; efficiency - time to complete AGMP; and usability - user experience). RESULTS Searches identified 6489 studies and 123 met criteria for inclusion (k = 0.81 title/abstract, k = 0.77 full-text). Most articles were published in 2020 (98%, n = 120) as letters/commentaries (58%, n = 71). Box systems represented 42% (n = 52) of systems described, while plastic sheet systems accounted for 54% (n = 66). The majority were used for airway management (67%, n = 83). Only half of articles described outcome measures (54%, n = 67); 82% (n = 55) reporting efficacy, 39% (n = 26) on usability, and 15% (n = 10) on efficiency. Efficacy of devices in containing aerosols was limited and frequently dependent on use of suction devices. CONCLUSIONS While use of various barrier enclosure devices has become widespread during this pandemic, objective data of efficacy, efficiency, and usability is limited. Further controlled studies are required before adoption into routine clinical practice.
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Affiliation(s)
- Courtney Price
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Maxim Ben-Yakov
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital - Emergency Department, University Health Network, Toronto, ON, Canada.
| | - Joseph Choi
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital - Emergency Department, University Health Network, Toronto, ON, Canada.
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, ON, Canada.
| | - Davy Tawadrous
- Division of Emergency Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital - Emergency Department, University Health Network, Toronto, ON, Canada.
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19
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Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit-What is the risk? Infect Control Hosp Epidemiol 2020; 42:669-677. [PMID: 33081858 PMCID: PMC7653228 DOI: 10.1017/ice.2020.1278] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities. Methods: In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards. Results: In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture. Conclusion: Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.
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Kumar N, Kumar A, Kumar A, Kumar A, Kumar S, Singh PK. Negative airflow isolation bed provides an option for NIV ventilation during COVID -19 pandemic. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2020; 34:59-60. [PMID: 38620638 PMCID: PMC7368648 DOI: 10.1016/j.tacc.2020.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Neeraj Kumar
- Department of Trauma & Emergency, All India Institute of Medical Sciences Patna, India
| | - Amarjeet Kumar
- Department of Trauma & Emergency, All India Institute of Medical Sciences Patna, India
| | - Abhyuday Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences Patna, India
| | - Sanjeev Kumar
- Department of CTVS, All India Institute of Medical Sciences Patna, India
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Baird BJ, Sung CK. Coronavirus Disease-19: Challenges Associated with the Treatment of Head and Neck Oncology and Laryngology Patients in the Coronavirus Disease-19 Era. Otolaryngol Clin North Am 2020; 53:1159-1170. [PMID: 33039099 PMCID: PMC7442893 DOI: 10.1016/j.otc.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This review explores the changes to practice associated with COVID-19 for providers treating patients with head and neck cancer and laryngeal pathology. The aim of the review is to highlight some of the challenges and considerations associated with treating this patient population during the pandemic. Additionally, it seeks to discuss some of the areas of concern related to ramping up clinical volume.
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Affiliation(s)
- Brandon J Baird
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 South Maryland Avenue, MC 1035, Chicago, IL 60637, USA.
| | - C Kwang Sung
- Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, 801 Welch Road, Stanford, CA 94304, USA
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22
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Rajajee V, Williamson CA. Use of a Novel Negative-Pressure Tent During Bedside Tracheostomy in COVID-19 Patients. Neurocrit Care 2020; 33:597-603. [PMID: 32770341 PMCID: PMC7413643 DOI: 10.1007/s12028-020-01068-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/25/2020] [Indexed: 01/25/2023]
Abstract
Background Many COVID-19 patients with neurological manifestations and respiratory failure remain dependent on mechanical ventilation and require tracheostomy, which is an aerosol generating procedure (AGP). The risk of SARS-CoV-2 transmission to healthcare staff during AGPs is well documented, and negative-pressure rooms are often unavailable. Innovative techniques to decrease risk to healthcare providers during AGPs are necessary. Our objective was to demonstrate the feasibility of percutaneous dilatational tracheostomy (PDT) performed using a novel prefabricated low-cost negative-pressure tent (AerosolVE). Methods Retrospective review of consecutive PDT procedures performed by neurointensivists on intubated adult patients with COVID-19 using the AerosolVE tent during the pandemic under an innovative clinical care protocol. The AerosolVE negative-pressure tent consists of a clear plastic canopy with slits for hand access attached to a U-shaped base with air vents. Air within the tent is drawn through a high-efficiency particulate air filter and released outside. Preliminary testing during simulated AGPs demonstrated negligible escape of particulate matter beyond the tent. The main outcome measure was successful completion of PDT and bronchoscopy within the AerosolVE tent, without complications. Results The patients were a 53-year-old man with multifocal ischemic stroke and acute respiratory distress syndrome (ARDS), 53-year-old woman with cerebellar hemorrhage and ARDS, and a 69-year-old man with ARDS. Pre-procedure FiO2 requirement was 40–50% and positive end-expiratory pressure (PEEP) 8–12 cm H2O. The tent was successfully positioned around the patient and PDT completed with real-time ultrasound guidance in all 3 patients. Bronchoscopy was performed to confirm tube position and perform pulmonary toilet. No complications occurred. Conclusions It is feasible to perform PDT on intubated COVID-19 patients using the AerosolVE negative-pressure tent. This is a promising low-cost device to decrease risk to healthcare providers during AGPs.
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Affiliation(s)
- Venkatakrishna Rajajee
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Health Care Center, SPC 5338, Ann Arbor, MI 48109 USA
- Department of Neurology, University of Michigan, Ann Arbor, MI USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI USA
| | - Craig A. Williamson
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive, 3552 Taubman Health Care Center, SPC 5338, Ann Arbor, MI 48109 USA
- Department of Neurology, University of Michigan, Ann Arbor, MI USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI USA
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23
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Shetty SS, Wollenberg B, Shabadi N, Kudpaje AS, Rao V, Merchant Y. Vicissitudes in oncological care during COVID19. Oral Oncol 2020; 107:104782. [PMID: 32414644 PMCID: PMC7211714 DOI: 10.1016/j.oraloncology.2020.104782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore 575001, India; Manipal Academy of Higher Education, A Constituent of MAHE, Light House Hill Road, India.
| | - Barbara Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675 München, Germany.
| | - Nikita Shabadi
- Coorg Institute of Dental Sciences, Virajpet 571218, India
| | | | - Vishal Rao
- Head and Neck Surgical Oncologist, Health Care Global Enterprises Ltd, Bangalore, India.
| | - Yash Merchant
- Dept. of Head and Neck Oncology, Health Care Global Enterprises Ltd, Bangalore, India
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24
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Jain U. Benefits and Limitations of Barrier Enclosures for Airway Procedures. J Cardiothorac Vasc Anesth 2020; 35:966-967. [PMID: 32782192 PMCID: PMC7364147 DOI: 10.1053/j.jvca.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Uday Jain
- San Mateo Medical Center, San Mateo, CA
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25
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Simpson JP, Wong DN, Verco L, Carter R, Dzidowski M, Chan PY. Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID-19 pandemic. Anaesthesia 2020; 75:1587-1595. [PMID: 32559315 PMCID: PMC7323428 DOI: 10.1111/anae.15188] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 01/25/2023]
Abstract
The COVID‐19 pandemic has led to the production of novel devices intended to protect airway managers during the aerosol‐generating procedure of tracheal intubation. Using an in‐situ simulation model, we evaluated laryngoscopist exposure of airborne particles sized 0.3 ‐ 5.0 microns using five aerosol containment devices (aerosol box; sealed box with and without suction; vertical drape; and horizontal drape) compared with no aerosol containment device. Nebulised saline was used as the aerosol‐generating model for 300 s, at which point, the devices were removed to assess particle spread. Primary outcome was the quantity and size of airborne particles measured at the level of the laryngoscopist’s head at 30, 60, 120 and 300 s, as well as 360 s (60 s after device removal). Airborne particles sizes of 0.3, 0.5, 1.0, 2.5 and 5.0 microns were quantified using an electronic airborne particle counter. Compared with no device use, the sealed intubation box with suction resulted in a decrease in 0.3, 0.5, 1.0 and 2.5 micron, but not 5.0 micron, particle exposure over all time‐periods (p = 0.003 for all time periods). Compared with no device use, the aerosol box showed an increase in 1.0, 2.5 and 5.0 micron airborne particle exposure at 300 s (p = 0.002, 0.008, 0.002, respectively). Compared with no device use, neither horizontal nor vertical drapes showed any difference in any particle size exposure at any time. Finally, when the patient coughed, use of the aerosol box resulted in a marked increase in airborne particle exposure compared with other devices or no device use. In conclusion, novel devices intended to protect the laryngoscopist require objective testing to ensure they are fit for purpose and do not result in increased airborne particle exposure.
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Affiliation(s)
- J P Simpson
- Intensive Care Services and Department of Anaesthesia and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia.,Department of Anaesthesia and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - D N Wong
- Department of Anaesthesia and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - L Verco
- Department of Anaesthesia and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - R Carter
- Ascent Vision Systems, Melbourne, Victoria, Australia
| | - M Dzidowski
- Ascent Vision Systems, Melbourne, Victoria, Australia
| | - P Y Chan
- Intensive Care Services and Department of Anaesthesia and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia.,Intensive Care Services, Eastern Health, Melbourne, Victoria, Australia
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26
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A COVID-19 Airway Management Innovation with Pragmatic Efficacy Evaluation: The Patient Particle Containment Chamber. Ann Biomed Eng 2020; 48:2371-2376. [PMID: 32856180 PMCID: PMC7453071 DOI: 10.1007/s10439-020-02599-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023]
Abstract
The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient's body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.
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