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Laguardia GCDA, Püschel VADA, Oliveira PPD, Faria LRD, Cavalcante RB, Coelho ADCO, Santos KBD, Carbogim FDC. Control of airborne particles in surgical procedures during the Covid-19 pandemic: scoping review. Rev Esc Enferm USP 2022; 56:e20210579. [PMID: 35899926 PMCID: PMC10111397 DOI: 10.1590/1980-220x-reeusp-2021-0579en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the technical and managerial strategies for the management and reduction of airborne particles production in surgical procedures settings during the Covid-19 pandemic. METHOD Scoping review, according to the Joana Briggs Institute methodology, based on documents indexed in MEDLINE, VHL, CINAHL Cochrane, Embase, Scopus, Web of Science, and gray literature, published in Portuguese, English, or Spanish. All studies from indexed scientific journals and recommendations published by international agencies or academic associations from 2019 to January 2022 were considered. Findings were summarized and analyzed using descriptive statistics and narrative synthesis. RESULTS Twenty-two studies were selected, 19 of which were published in English, two in Spanish, one in Portuguese, with a predominance of literature reviews. Findings were categorized into recommendations for the environment, the team, and the surgical technique. CONCLUSION The review mapped the technical and managerial strategies for the management and reduction of the airborne particles production in surgical procedures settings. They involve from the use of personal protective equipment, training, anesthetic modality, airway manipulation, to the execution of the surgical technique.
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Affiliation(s)
| | - Vilanice Alves de Araújo Püschel
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, SP, Brazil
| | | | | | | | | | - Kelli Borges Dos Santos
- Universidade Federal de Juiz de Fora, Faculdade de Enfermagem, Juiz de Fora, MG, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, SP, Brazil
| | - Fábio da Costa Carbogim
- Universidade Federal de Juiz de Fora, Faculdade de Enfermagem, Juiz de Fora, MG, Brazil.,Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), São Paulo, SP, Brazil
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Duarte-Medrano G, Sorbello M, Susunaga-Hope RR, Fuentes-Castro PI, Avila-OrtIz BC, Velasco-Godinez AP, Contreras-Garcia WY, Pineda-Castillo MA, Urdaneta F, Téllez-Ávila FI. Aerosol boxes for airway management in coronavirus disease patients: a clinical retrospective study in Mexico. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2022; 2:32. [PMID: 37386573 PMCID: PMC10246106 DOI: 10.1186/s44158-022-00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/07/2022] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Significant concerns raise for the healthcare workers involved in airway management of patients diagnosed with coronavirus 2019 disease (COVID-19). Due to shortages of personal protective equipment (PPE), barrier enclosure systems such as aerosol box (AB) have been proposed worldwide. The aim of this study was to evaluate our experience using AB as protective equipment in patients with COVID-19 in a third-level center in Mexico. METHODS A retrospective study of COVID-19 patients requiring airway management using an AB in the Hospital Central Sur de Alta Especialidad de Pemex in Mexico City from March 1 to June 1, 2020. Antropometric data, pre-intubation vital signs, and laboratory tests were recorded; the primary endpoints were intubation success rate and complications associated with AB and patients' mortality. As a secondary endpoint, AB subjective evaluation was explored by administering a survey after airway management procedures. RESULTS Thirty-nine patients for a total of 40 intubations were documented. Thirty-one (77.5%) were men, with a mean age of 61.65 years; successful intubation occurred in 39 (97.55%) of the procedures, and AB was used in 36 (90%) of intubations, with success in 28 (70.0%); A Cormack-Lehane grade 3 view was recorded in 18 patients (46.2%), and during the procedure, the AB had to be removed in 8 (22.2%) cases, with migration documented in 91.6% of cases. The 30-day mortality was 48.71%, with 23.0% of patients discharged. 83.3% of surveyed anesthesiologists reported significant limitations in manipulating airway devices with AB used. CONCLUSION Our data indicate that in clinical practice, the use of AB may hinder airway management and decrease the intubation success rate and may also result in patients' injury. Further studies are necessary to validate the use of AB in clinical practice, and they should not replace certified PPE.
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Affiliation(s)
- Gilberto Duarte-Medrano
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | - Massimiliano Sorbello
- Anaesthesia, and Intensive Care, Policlinico San Marco University Hospital, Viale C. A. Ciampi, 95100, Catania, Italy.
| | | | | | - Beatriz C Avila-OrtIz
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | | | - Wendy Y Contreras-Garcia
- Anesthesiology Department of the South-Central Hospital of High Specialty Pemex, Mexico City, Mexico
| | | | - Felipe Urdaneta
- Clinical Professor Anesthesiology, Department of Anesthesiology, University of Florida/NFSGVHS, Florida, USA
| | - Félix Ignacio Téllez-Ávila
- Gastrointestinal Endoscopy Department of the National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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Kowa CY, Jin Z, Gan TJ. Framework, component, and implementation of enhanced recovery pathways. J Anesth 2022; 36:648-660. [PMID: 35789291 PMCID: PMC9255474 DOI: 10.1007/s00540-022-03088-x] [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: 06/30/2021] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
The introduction of enhanced recovery pathways (ERPs) has led to a considerable paradigm shift towards evidence-based, multidisciplinary perioperative care. Such pathways are now widely implemented in a variety of surgical specialties, with largely positive results. In this narrative review, we summarize the principles, components and implementation of ERPs, focusing on recent developments in the field. We also discuss ‘special cases’ in ERPs, including: surgery in frail patients; emergency procedures; and patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2/COVID-19).
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Affiliation(s)
- Chao-Ying Kowa
- Department of Anaesthesia, Whittington Hospital, Magdala Ave, London, N19 5NF, UK
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, 11794-8480, USA.
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Survey of coronavirus disease 2019 (COVID-19) infection control policies at leading US academic hospitals in the context of the initial pandemic surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant. Infect Control Hosp Epidemiol 2022; 44:597-603. [PMID: 35705223 PMCID: PMC9253430 DOI: 10.1017/ice.2022.155] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess coronavirus disease 2019 (COVID-19) infection policies at leading US medical centers in the context of the initial wave of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant. DESIGN Electronic survey study eliciting hospital policies on masking, personal protective equipment, cohorting, airborne-infection isolation rooms (AIIRs), portable HEPA filters, and patient and employee testing. SETTING AND PARTICIPANTS "Hospital epidemiologists from U.S. News top 20 hospitals and 10 hospitals in the CDC Prevention Epicenters program." As it is currently written, it implies all 30 hospitals are from the CDC Prevention Epicenters program, but that only applies to 10 hospitals. Alternatively, we could just say "Hospital epidemiologists from 30 leading US hospitals." METHODS Survey results were reported using descriptive statistics. RESULTS Of 30 hospital epidemiologists surveyed, 23 (77%) completed the survey between February 15 and March 3, 2022. Among the responding hospitals, 18 (78%) used medical masks for universal masking and 5 (22%) used N95 respirators. 16 hospitals (70%) required universal eye protection. 22 hospitals (96%) used N95s for routine COVID-19 care and 1 (4%) reserved N95s for aerosol-generating procedures. 2 responding hospitals (9%) utilized dedicated COVID-19 wards; 8 (35%) used mixed COVID-19 and non-COVID-19 units; and 13 (57%) used both dedicated and mixed units. 4 hospitals (17%) used AIIRs for all COVID-19 patients, 10 (43%) prioritized AIIRs for aerosol-generating procedures, 3 (13%) used alternate risk-stratification criteria (not based on aerosol-generating procedures), and 6 (26%) did not routinely use AIIRs. 9 hospitals (39%) did not use portable HEPA filters, but 14 (61%) used them for various indications, most commonly as substitutes for AIIRs when unavailable or for specific high-risk areas or situations. 21 hospitals (91%) tested asymptomatic patients on admission, but postadmission testing strategies and preferred specimen sites varied substantially. 5 hospitals (22%) required regular testing of unvaccinated employees and 1 hospital (4%) reported mandatory weekly testing even for vaccinated employees during the SARS-CoV-2 omicron surge. CONCLUSIONS COVID-19 infection control practices in leading hospitals vary substantially. Clearer public health guidance and transparency around hospital policies may facilitate more consistent national standards.
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A Brief Analysis of a New Device to Prevent Early Intubation in Hypoxemic Patients: An Observational Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The need for mechanical ventilation is one of the main concerns related to the care of patients with COVID-19. The aim of this study is to evaluate the efficacy of a bubble device for oxygen supplementation. This device was implemented for the selected patients hospitalized with severe COVID-19 pneumonia with persistent low oxygen saturation. Patients were selected in three major COVID-19 hospitals of Bahia state in Brazil from July to November 2020, where they remained with the device for seven days and were monitored for different factors, such as vital signs, oximetry evaluation, and arterial blood gasometry. Among the 51 patients included in the study, 68.63% successfully overcame hypoxemia without the necessity to be transferred to mechanical ventilation, whereas 31.37% required tracheal intubation (p value < 0.05). There was no difference of note on the analysis of the clinical data, chemistry, and hematological evaluation, with the exception of the SpO2 on follow-up days. Multivariate analysis revealed that the independent variable, male sex, SpO2, and non-inhaled mask, was associated with the necessity of requiring early mechanical ventilation. We concluded that this bubble device should be a prior step to be utilized before indication of mechanical ventilation in patients with persistent hypoxemia of severe COVID-19 pneumonia.
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Shrimpton AJ, Brown JM, Cook TM, Penfold CM, Reid JP, Pickering AE. Quantitative evaluation of aerosol generation from upper airway suctioning assessed during tracheal intubation and extubation sequences in anaesthetized patients. J Hosp Infect 2022; 124:13-21. [PMID: 35276282 PMCID: PMC9172909 DOI: 10.1016/j.jhin.2022.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence. AIM To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients. METHODS This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3-10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation. FINDINGS Aerosol was reliably detected {median 65 [interquartile range (IQR) 39-259] particles/L} above background [median 4.8 (IQR 1-7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0-12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30-75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600-4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300-1826) particles/L, P<0.0001]. CONCLUSION Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
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Affiliation(s)
- A J Shrimpton
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - C M Penfold
- Bristol Biomedical Research Centre, University of Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Gregson FKA, Shrimpton AJ, Hamilton F, Cook TM, Reid JP, Pickering AE, Pournaras DJ, Bzdek BR, Brown J. Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy. Gut 2022; 71:871-878. [PMID: 34187844 PMCID: PMC8245282 DOI: 10.1136/gutjnl-2021-324588] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine if oesophago-gastro-duodenoscopy (OGD) generates increased levels of aerosol in conscious patients and identify the source events. DESIGN A prospective, environmental aerosol monitoring study, undertaken in an ultraclean environment, on patients undergoing OGD. Sampling was performed 20 cm away from the patient's mouth using an optical particle sizer. Aerosol levels during OGD were compared with tidal breathing and voluntary coughs within subject. RESULTS Patients undergoing bariatric surgical assessment were recruited (mean body mass index 44 and mean age 40 years, n=15). A low background particle concentration in theatres (3 L-1) enabled detection of aerosol generation by tidal breathing (mean particle concentration 118 L-1). Aerosol recording during OGD showed an average particle number concentration of 595 L-1 with a wide range (3-4320 L-1). Bioaerosol-generating events, namely, coughing or burping, were common. Coughing was evoked in 60% of the endoscopies, with a greater peak concentration and a greater total number of sampled particles than the patient's reference voluntary coughs (11 710 vs 2320 L-1 and 780 vs 191 particles, n=9 and p=0.008). Endoscopies with coughs generated a higher level of aerosol than tidal breathing, whereas those without coughs were not different to the background. Burps also generated increased aerosol concentration, similar to those recorded during voluntary coughs. The insertion and removal of the endoscope were not aerosol generating unless a cough was triggered. CONCLUSION Coughing evoked during OGD is the main source of the increased aerosol levels, and therefore, OGD should be regarded as a procedure with high risk of producing respiratory aerosols. OGD should be conducted with airborne personal protective equipment and appropriate precautions in those patients who are at risk of having COVID-19 or other respiratory pathogens.
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Affiliation(s)
| | - Andrew J Shrimpton
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - Fergus Hamilton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals NHS Trust, Bath, and Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Anthony E Pickering
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
- Bristol Anaesthesia, Pain and Critical Care Sciences, Translational Health Sciences, Bristol Medical School, Bristol, UK
| | - Dimitri J Pournaras
- Department of Upper Gastrointestinal and Bariatric/Metabolic Surgery, North Bristol NHS Trust, Bristol, UK
| | - Bryan R Bzdek
- School of Chemistry, University of Bristol, Bristol, UK
| | - Jules Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
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Grudzinski AL, Sun B, Zhang M, Crnic A, Djokhdem AH, Hanna M, Montroy J, Duggan LV, Hamilton GM, Fergusson DA, Boet S, McIsaac DI, Lalu MM. Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review. Can J Anaesth 2022; 69:644-657. [PMID: 35112304 PMCID: PMC8809630 DOI: 10.1007/s12630-022-02199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Numerous guideline recommendations for airway and perioperative management during the COVID-19 pandemic have been published. We identified, synthesized, and compared guidelines intended for anesthesiologists. SOURCE Member society websites of the World Federation of Societies of Anesthesiologists and the European Society of Anesthesiologists were searched. Recommendations that focused on perioperative airway management of patients with proven or potential COVID-19 were included. Accelerated screening was used; data were extracted by one reviewer and verified by a second. Data were organized into themes based on perioperative phase of care. PRINCIPAL FINDINGS Thirty unique sets of recommendations were identified. None reported methods for systematically searching or selecting evidence to be included. Four were updated following initial publication. For induction and airway management, most recommended minimizing personnel and having the most experienced anesthesiologist perform tracheal intubation. Significant congruence was observed among recommendations that discussed personal protective equipment. Of those that discussed tracheal intubation methods, most (96%) recommended videolaryngoscopy, while discordance existed regarding use of flexible bronchoscopy. Intraoperatively, 23% suggested specific anesthesia techniques and most (63%) recommended a specific operating room for patients with COVID-19. Postoperatively, a minority discussed extubation procedures (33%), or care in the recovery room (40%). Non-technical considerations were discussed in 27% and psychological support for healthcare providers in 10%. CONCLUSION Recommendations for perioperative airway management of patients with COVID-19 overlap to a large extent but also show significant differences. Given the paucity of data early in the pandemic, it is not surprising that identified publications largely reflected expert opinion rather than empirical evidence. We suggest future efforts should promote coordinated responses and provide suggestions for studying and establishing best practices in perioperative patients. STUDY REGISTRATION Open Science Framework ( https://osf.io/a2k4u/ ); date created, 26 March 2020.
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Affiliation(s)
- Alexa Lynn Grudzinski
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Billy Sun
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - MengQi Zhang
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Agnes Crnic
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | | | - Mary Hanna
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Joshua Montroy
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Gavin M Hamilton
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
| | - Dean A Fergusson
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, Francophone Affairs, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- AIMS Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Manoj M Lalu
- Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada.
- Blueprint Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada.
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Minoguchi K, Isii A, Nakamura T, Sato H, Abe T, Kawakami H, Nakamura K, Goto T. Effects of wearing surgical masks on fraction of inspired oxygen in spontaneously breathing patients: improving safety for frontline healthcare professionals under pandemic situations. BMC Anesthesiol 2022; 22:108. [PMID: 35436860 PMCID: PMC9014278 DOI: 10.1186/s12871-022-01649-x] [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: 11/24/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During pandemic situations, many guidelines recommend that surgical masks be worn by both healthcare professionals and infected patients in healthcare settings. The purpose of this study was to clarify the levels and changes of oxygen concentration over time while oxygen was administered over a surgical mask. METHODS Patients scheduled to undergo general anesthesia (n = 99) were enrolled in this study. First, patients were administered oxygen at 6 L/min via an oxygen mask over a surgical mask for 5 min. The patients removed the surgical mask and then took a 3-min break; thereafter, the same amount of oxygen was administered for another 5 min via the oxygen mask. We measured the fraction of inspired oxygen (FiO2), the end-tidal CO2 (EtCO2), and respiratory frequency every minute for 5 min, both while administering oxygen with and without a surgical mask. The FiO2 was measured at the beginning of inspiration and the EtCO2 was measured at the end of expiration. RESULTS The FiO2 at 5 min was significantly lower when breathing with a surgical mask than that without it (mean difference: 0.08 [95% CI: 0.067-0.10]; p < 0.001). In contrast, the EtCO2 at 5 min was significantly higher when breathing with a surgical mask than that without it (mean difference: 11.9 mmHg [95% CI: 10.9-12.9]; p < 0.001). CONCLUSION The FiO2 was lower when oxygen was administered over surgical masks than when patients did not wear surgical masks. Oxygen flow may need to be adjusted in moderately ill patients requiring oxygen administration.
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Affiliation(s)
- Kazuhiro Minoguchi
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Akira Isii
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Toshiki Nakamura
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hitoshi Sato
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan. .,Department of Clinical Quality Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Takeru Abe
- Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hiromasa Kawakami
- Department of Anesthesiology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Kyota Nakamura
- Department of Clinical Quality Management, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Quality and Safety in Healthcare, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Intensive Care Unit, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Oksanen L, Sanmark E, Sofieva S, Rantanen N, Lahelma M, Anttila V, Lehtonen L, Atanasova N, Pesonen E, Geneid A, Hyvärinen A. Aerosol generation during general anesthesia is comparable to coughing: An observational clinical study. Acta Anaesthesiol Scand 2022; 66:463-472. [PMID: 34951703 PMCID: PMC9303240 DOI: 10.1111/aas.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intubation, laryngoscopy, and extubation are considered highly aerosol-generating procedures, and additional safety protocols are used during COVID-19 pandemic in these procedures. However, previous studies are mainly experimental and have neither analyzed staff exposure to aerosol generation in the real-life operating room environment nor compared the exposure to aerosol concentrations generated during normal patient care. To assess operational staff exposure to potentially infectious particle generation during general anesthesia, we measured particle concentration and size distribution with patients undergoing surgery with Optical Particle Sizer. METHODS A single-center observative multidisciplinary clinical study in Helsinki University Hospital with 39 adult patients who underwent general anesthesia with tracheal intubation. Mean particle concentrations during different anesthesia procedures were statistically compared with cough control data collected from 37 volunteers to assess the differences in particle generation. RESULTS This study measured 25 preoxygenations, 30 mask ventilations, 28 intubations, and 24 extubations. The highest total aerosol concentration of 1153 particles (p)/cm³ was observed during mask ventilation. Preoxygenations, mask ventilations, and extubations as well as uncomplicated intubations generated mean aerosol concentrations statistically comparable to coughing. It is noteworthy that difficult intubation generated significantly fewer aerosols than either uncomplicated intubation (p = .007) or coughing (p = 0.006). CONCLUSIONS Anesthesia induction generates mainly small (<1 µm) aerosol particles. Based on our results, general anesthesia procedures are not highly aerosol-generating compared with coughing. Thus, their definition as high-risk aerosol-generating procedures should be re-evaluated due to comparable exposures during normal patient care. IMPLICATION STATEMENT The list of aerosol-generating procedures guides the use of protective equipments in hospitals. Intubation is listed as a high-risk aerosol-generating procedure, however, aerosol generation has not been measured thoroughly. We measured aerosol generation during general anesthesia. None of the general anesthesia procedures generated statistically more aerosols than coughing and thus should not be considered as higher risk compared to normal respiratory activities.
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Affiliation(s)
- Lotta‐Maria Oksanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics—Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Enni Sanmark
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics—Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Svetlana Sofieva
- Faculty of Biological and Environmental SciencesMolecular and Integrative Biosciences Research ProgrammeUniversity of HelsinkiHelsinkiFinland
| | - Noora Rantanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics—Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Mari Lahelma
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics—Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
- Faculty of Science, Mathematics and StatisticsUniversity of HelsinkiHelsinkiFinland
| | - Veli‐Jukka Anttila
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Inflammation CentreHelsinki University HospitalHelsinkiFinland
| | - Lasse Lehtonen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Diagnostic CentreHUSLABHelsinki University HospitalHelsinkiFinland
| | - Nina Atanasova
- Faculty of Biological and Environmental SciencesMolecular and Integrative Biosciences Research ProgrammeUniversity of HelsinkiHelsinkiFinland
- Finnish Meteorological InstituteHelsinkiFinland
| | - Eero Pesonen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Anesthesiology, Intensive Care and Pain MedicineHelsinki University HospitalHelsinkiFinland
| | - Ahmed Geneid
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics—Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
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Bhatia K. Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study. Anaesthesia 2022; 77:389-397. [PMID: 35226768 PMCID: PMC9111485 DOI: 10.1111/anae.15672] [Citation(s) in RCA: 2] [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] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/11/2022]
Abstract
Since the start of the COVID-19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS-CoV-2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS-CoV-2 across 10 hospitals in the north-west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS-CoV-2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID-19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64-1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6-96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19-2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04-2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47-3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16-2.12; p = 0.008); and a higher critical care utilisation rate both pre- (8% vs. 0%, p = 0.001) and post-delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83-6.52; p = 0.001). Eight neonates tested positive for SARS-CoV-2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78-1.57; p = 0.55). In women with COVID-19, non-neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID-19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.
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Affiliation(s)
- K. Bhatia
- Manchester University NHS Foundation TrustManchesterUK
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62
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Cumbo-Nacheli G, Colt H, Agrawal A, Cicenia J, Corbetta L, Goel AD, Goga A, Lee HJ, Murgu S, Pannu J, Senitko M, Tarantini F, Vujacich P, Williamson J, Yap E, Lentz RJ. Bronchoscopy in Patients With Known or Suspected COVID-19: Results From the Global Pandemic SARS-CoV-2 Bronchoscopy Database (GPS-BD). J Bronchology Interv Pulmonol 2022; 29:146-154. [PMID: 35318989 DOI: 10.1097/lbr.0000000000000805] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amid the Coronavirus Disease 2019 (COVID-19) pandemic, the benefits and risks of bronchoscopy remain uncertain. This study was designed to characterize bronchoscopy-related practice patterns, diagnostic yields, and adverse events involving patients with known or suspected COVID-19. METHODS An online survey tool retrospectively queried bronchoscopists about their experiences with patients with known or suspected COVID-19 between March 20 and August 20, 2020. Collected data comprised the Global Pandemic SARS-CoV-2 Bronchoscopy Database (GPS-BD). All bronchoscopists and patients were anonymous with no direct investigator-to-respondent contact. RESULTS Bronchoscopy procedures involving 289 patients from 26 countries were analyzed. One-half of patients had known COVID-19. Most (82%) had at least 1 pre-existing comorbidity, 80% had at least 1 organ failure, 51% were critically ill, and 37% were intubated at the time of the procedure. Bronchoscopy was performed with diagnostic intent in 166 (57%) patients, yielding a diagnosis in 86 (52%). and management changes in 80 (48%). Bronchoscopy was performed with therapeutic intent in 71 (25%) patients, mostly for secretion clearance (87%). Complications attributed to bronchoscopy or significant clinical decline within 12 hours of the procedure occurred in 24 (8%) cases, with 1 death. CONCLUSION Results from this international database provide a widely generalizable characterization of the benefits and risks of bronchoscopy in patients with known or suspected COVID-19. Bronchoscopy in this setting has reasonable clinical benefit, with diagnosis and/or management change resulting from about half of the diagnostic cases. However, it is not without risk, especially in patients with limited physiological reserve.
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Affiliation(s)
- Gustavo Cumbo-Nacheli
- Spectrum Health, Michigan State University School of Human Medicine, Grand Rapids, MI
| | - Henri Colt
- University of California, Irvine Medical Center, Irvine, CA
| | - Abhinav Agrawal
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | | | | | - Akhil D Goel
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ameena Goga
- Steve Biko Academic Hospital, Praeteria, South Africa
| | | | | | | | - Michal Senitko
- University of Mississippi Medical Center School of Medicine, Jackson, MS
| | | | | | - Jonathan Williamson
- South West Clinical School, University of New South Wales
- MQ Health Respiratory and Sleep, Macquarie University, Sydney, Australia
| | - Elaine Yap
- Middlemore Hospital, Auckland, New Zealand
| | - Robert J Lentz
- Vanderbilt University Medical Center
- Department of Veterans Affairs Medical Center, Nashville, TN
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63
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Schimmel M, Berkowitz DM. Pulmonary Procedures in the COVID-19 Era. CURRENT PULMONOLOGY REPORTS 2022; 11:39-47. [PMID: 35371910 PMCID: PMC8960220 DOI: 10.1007/s13665-022-00285-7] [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] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review The purpose of this review is to discuss the impact of the COVID-19 pandemic on pulmonary procedures, including new guidelines, restrictions, techniques, and overall effect on patient care. Recent Findings SARS-CoV-2 predominately impacts the pulmonary system and can result in a severe lower respiratory tract infection. Early guidelines based largely on data from the SARS epidemic recommended significant restrictions on procedure volume out of concern for healthcare worker safety. Newer data suggests relative safety in performing airway and pleural procedures as long as appropriate precautions are followed and new techniques are utilized. The introduction of effective vaccines and more reliable testing has led to a re-expansion of elective procedures. Summary Many guidelines and expert statements exist for the management and practice of pulmonary procedures during the COVID-19 pandemic. A flexible and individualized approach may be necessary as our understanding of COVID-19 continues to evolve.
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Affiliation(s)
- Matt Schimmel
- Division of Interventional Pulmonology, Emory University, Atlanta, GA USA
| | - David M. Berkowitz
- Division of Interventional Pulmonology, Emory University, Atlanta, GA USA
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Peterson MB, Gurnaney HG, Disma N, Matava C, Jagannathan N, Stein ML, Liu H, Kovatsis PG, von Ungern‐Sternberg BS, Fiadjoe JE. Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study. Anaesthesia 2022; 77:649-658. [PMID: 35319088 PMCID: PMC9111470 DOI: 10.1111/anae.15716] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/26/2022] [Accepted: 03/02/2022] [Indexed: 01/10/2023]
Abstract
Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.
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Affiliation(s)
- M. B. Peterson
- Department of AnesthesiologyChildren's Hospital Colorado/University of Colorado School of MedicineAuroraCOUSA
| | - H. G. Gurnaney
- Department of Anesthesiology and Critical Care MedicineThe Children's Hospital of Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
| | - N. Disma
- Unit for Research and Innovation, Department of Pediatric AnesthesiaIstituto Giannina GasliniGenovaItaly
| | - C. Matava
- Department of Anesthesia and Pain MedicineHospital for Sick ChildrenTorontoONCanada
| | - N. Jagannathan
- Ann and Robert Lurie Children's Hospital of Chicago/Northwestern UniversityChicagoILUSA
| | - M. L. Stein
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - H. Liu
- Data Science and Biostatistics Unit, Department of Biomedical and HealthThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - P. G. Kovatsis
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - B. S. von Ungern‐Sternberg
- Department of Anesthesia and Pain MedicinePerth Children's Hospital, Telethon Kids Institute, The University of Western AustraliaPerthAustralia
| | - J. E. Fiadjoe
- Department of Anesthesiology and Critical Care MedicineThe Children's Hospital of Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
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65
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Monitoring respiratory mechanics by oscillometry in COVID-19 patients receiving non-invasive respiratory support. PLoS One 2022; 17:e0265202. [PMID: 35312682 PMCID: PMC8936489 DOI: 10.1371/journal.pone.0265202] [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: 08/03/2021] [Accepted: 02/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background Non-invasive ventilation (NIV) has been increasingly used in COVID-19 patients. The limited physiological monitoring and the unavailability of respiratory mechanic measures, usually obtainable during invasive ventilation, is a limitation of NIV for ARDS and COVID-19 patients management. Objectives This pilot study was aimed to evaluate the feasibility of non-invasively monitoring respiratory mechanics by oscillometry in COVID-19 patients with moderate-severe acute respiratory distress syndrome (ARDS) receiving NIV. Method 15 COVID-19 patients affected by moderate-severe ARDS at the RICU (Respiratory Intensive Care Unit) of the University hospital of Cattinara, Trieste, Italy were recruited. Patients underwent oscillometry tests during short periods of spontaneous breathing between NIV sessions. Results Oscillometry proved to be feasible, reproducible and well-tolerated by patients. At admission, 8 of the 15 patients showed oscillometry parameters within the normal range which further slightly improved before discharge. At discharge, four patients had still abnormal respiratory mechanics, not exclusively linked to pre-existing respiratory comorbidities. Lung mechanics parameters were not correlated with oxygenation. Conclusions Our results suggest that lung mechanics provide complementary information for improving patients phenotyping and personalisation of treatments during NIV in COVID 19 patients, especially in the presence of respiratory comorbidities where deterioration of lung mechanics may be less coupled with changes in oxygenation and more difficult to identify. Oscillometry may provide a valuable tool for monitoring lung mechanics in COVID 19 patients receiving NIV.
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66
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Li Y, Fu Y, Zhang Y, Yu S, Luo J, Li Y, Wang C, Zhu J, Li H. An overview of COVID-19 aerosol box for preventing droplet and aerosol contaminations in healthcare providers performing airway intubation. Drug Dev Ind Pharm 2022; 47:1693-1699. [PMID: 35285771 DOI: 10.1080/03639045.2022.2053984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 is caused by the SARS-CoV-2, which is extremely infectious. Numerous virologist suggestions and guidelines advised using P2/N95 masks, gloves, goggles, face-shields, and frocks or gowns as routine specific protective tools during airway management to protect healthcare personnel from infection (PPE). However, numerous imitation research has indicated that conventional PPE cannot adequately protect healthcare personnel. Since then, numerous firms and healthcare professionals have created their personal reformed devices "aerosol containment devices" (ACD). Their usage has expanded throughout the world without being properly evaluated for usefulness, efficacy, or safety. The practice of "ACD" has been shown to make tracheal intubation (TI) more problematic in several simulated tests. Furthermore, the device should limit the transmission of droplets from a patient; however, it might put healthcare personnel at danger of being exposed to greater levels of viral aerosols. Consequently, the existing state of information suggests that "ACD" deprived of a vacuum mechanism can simply protect healthcare personnel against viral transmission to a limited extent. We search various databases for the literatures with keywords "COVID-19", "aerosol box", "aerosol contaminations" and "droplet contaminations. The current review focused on the aerosol box from various perspectives, including their mechanism, optimum time of use, the spread of aerosol control, current gaps and future perspective for bridging those gaps.
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Affiliation(s)
- Yan Li
- The outpatient department, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yujun Fu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yunwei Zhang
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Shuai Yu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jinhong Luo
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Yuanyuan Li
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Caihong Wang
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Jingjing Zhu
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Huiling Li
- Institute of Tropical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China.,Hainan Clinical Medical school of Southern Medical University, Sanya, Hainan, China
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Hamilton FW, Gregson FKA, Arnold DT, Sheikh S, Ward K, Brown J, Moran E, White C, Morley AJ, Bzdek BR, Reid JP, Maskell NA, Dodd JW. Aerosol emission from the respiratory tract: an analysis of aerosol generation from oxygen delivery systems. Thorax 2022. [PMID: 34737195 DOI: 10.1101/2021.01.29.21250552] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
INTRODUCTION continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) provide enhanced oxygen delivery and respiratory support for patients with severe COVID-19. CPAP and HFNO are currently designated as aerosol-generating procedures despite limited high-quality experimental data. We aimed to characterise aerosol emission from HFNO and CPAP and compare with breathing, speaking and coughing. MATERIALS AND METHODS Healthy volunteers were recruited to breathe, speak and cough in ultra-clean, laminar flow theatres followed by using CPAP and HFNO. Aerosol emission was measured using two discrete methodologies, simultaneously. Hospitalised patients with COVID-19 had cough recorded using the same methodology on the infectious diseases ward. RESULTS In healthy volunteers (n=25 subjects; 531 measures), CPAP (with exhalation port filter) produced less aerosol than breathing, speaking and coughing (even with large >50 L/min face mask leaks). Coughing was associated with the highest aerosol emissions of any recorded activity. HFNO was associated with aerosol emission, however, this was from the machine. Generated particles were small (<1 µm), passing from the machine through the patient and to the detector without coalescence with respiratory aerosol, thereby unlikely to carry viral particles. More aerosol was generated in cough from patients with COVID-19 (n=8) than volunteers. CONCLUSIONS In healthy volunteers, standard non-humidified CPAP is associated with less aerosol emission than breathing, speaking or coughing. Aerosol emission from the respiratory tract does not appear to be increased by HFNO. Although direct comparisons are complex, cough appears to be the main aerosol-generating risk out of all measured activities.
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Affiliation(s)
- Fergus W Hamilton
- Infection Science, North Bristol NHS Trust, Westbury on Trym, UK
- MRC Integrative Epidemiology Unit, Bristol, UK
| | - Florence K A Gregson
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - David T Arnold
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Sadiyah Sheikh
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - Kirsty Ward
- Physiotherapy Department, North Bristol NHS Trust, Westbury on Trym, UK
| | - Jules Brown
- Anaesthetics and Intensive Care Department, North Bristol NHS Trust, Westbury on Trym, UK
| | - Ed Moran
- Infectious Diseases, North Bristol NHS Trust, Bristol, UK
| | - Carrie White
- Research and Development, North Bristol NHS Trust, Westbury on Trym, UK
| | - Anna J Morley
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Bryan R Bzdek
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - Jonathan P Reid
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - Nicholas A Maskell
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - James William Dodd
- MRC Integrative Epidemiology Unit, Bristol, UK
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
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Schmidt AP, Módolo NSP, de Amorim CG, Simões CM, Kraychete DC, Joaquim EHG, Lineburger EB, Papa FV, Fernandes FC, Mendes FF, Guimarães GMN, Barros GAM, Silva-Jr JM, Navarro E Lima LH, Azi LMTA, Carvalho LIM, Stefani LC, Garcia LV, Malbouisson LMS, Salgado-Filho MF, Nascimento Junior PD, Alves RL, Carvalho VH, Quintão VC, Carmona MJC. Two years of the COVID-19 pandemic: an anesthesiology perspective. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2022; 72:165-168. [PMID: 35189166 PMCID: PMC8856750 DOI: 10.1016/j.bjane.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 12/30/2022]
Affiliation(s)
- André P Schmidt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Norma S P Módolo
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | | | | | | | | | | | | | - Fátima C Fernandes
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Florentino F Mendes
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Guilherme A M Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Botucatu, SP, Brazil
| | - João M Silva-Jr
- Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
| | | | | | | | - Luciana C Stefani
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Luis V Garcia
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Luiz Marcelo S Malbouisson
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | | | | | | | - Vinicius C Quintão
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Maria José C Carmona
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Nasa P, Azoulay E, Chakrabarti A, Divatia JV, Jain R, Rodrigues C, Rosenthal VD, Alhazzani W, Arabi YM, Bakker J, Bassetti M, De Waele J, Dimopoulos G, Du B, Einav S, Evans L, Finfer S, Guérin C, Hammond NE, Jaber S, Kleinpell RM, Koh Y, Kollef M, Levy MM, Machado FR, Mancebo J, Martin-Loeches I, Mer M, Niederman MS, Pelosi P, Perner A, Peter JV, Phua J, Piquilloud L, Pletz MW, Rhodes A, Schultz MJ, Singer M, Timsit JF, Venkatesh B, Vincent JL, Welte T, Myatra SN. Infection control in the intensive care unit: expert consensus statements for SARS-CoV-2 using a Delphi method. THE LANCET. INFECTIOUS DISEASES 2022; 22:e74-e87. [PMID: 34774188 PMCID: PMC8580499 DOI: 10.1016/s1473-3099(21)00626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 02/07/2023]
Abstract
During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.
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Affiliation(s)
- Prashant Nasa
- NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Elie Azoulay
- Saint-Louis Teaching Hospital, APHP, University of Paris, Paris, France
| | | | | | - Ravi Jain
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Camilla Rodrigues
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | | | | | - Yaseen M Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Jan Bakker
- New York University Grossman School of Medicine, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Erasmus University Medical Center, Rotterdam, Netherlands; Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - George Dimopoulos
- Attikon University Hospital, Athens, Greece; National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Bin Du
- State Key Laboratory of Rare, Complex and Critical Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Sharon Einav
- Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Imperial College London, London, UK
| | - Claude Guérin
- University de Lyon, Lyon, France; Institut Mondor de Recherches Biomédicales, Créteil, France
| | - Naomi E Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Newton, Adelaide, SA, Australia
| | - Samir Jaber
- Hôpital Saint-Éloi, Montpellier University Hospital, Montpellier, France
| | - Ruth M Kleinpell
- Vanderbilt University School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Younsuck Koh
- College of Medicine, University of Ulsan College of Medicine, University of Ulsan, Seoul, South Korea
| | - Marin Kollef
- Washington University School of Medicine, Washington University, St Louis, MO, USA
| | - Mitchell M Levy
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Flavia R Machado
- Hospital Sao Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Pelosi
- IRCCS for Oncology and Neurosciences, San Martino Policlinico Hospital, Genoa, Italy; University of Genoa, Genoa, Italy
| | - Anders Perner
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jason Phua
- Alexandra Hospital, National University Health System, Singapore; National University Hospital, National University Health System, Singapore
| | - Lise Piquilloud
- University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Andrew Rhodes
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marcus J Schultz
- Amsterdam University Medical Centers, Locatie AMC, Amsterdam, Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | | | | | - Tobias Welte
- German Center of Lung Research, Hannover, Germany
| | - Sheila N Myatra
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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Pope C, Harrop-Griffiths W, Brown J. Aerosol-generating procedures and the anaesthetist. BJA Educ 2022; 22:52-59. [PMID: 35035993 PMCID: PMC8749387 DOI: 10.1016/j.bjae.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- C. Pope
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK,Corresponding author:
| | | | - J. Brown
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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71
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Klompas M. New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses. Semin Respir Crit Care Med 2022; 43:295-303. [PMID: 35042261 DOI: 10.1055/s-0041-1740582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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72
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Kerai S, Singh R, Saxena KN, Desai SD. Assessment of Risk Factors for Coronavirus Disease-2019 in Healthcare Workers: A Case–Control Study. Indian J Crit Care Med 2022; 26:76-84. [PMID: 35110849 PMCID: PMC8783233 DOI: 10.5005/jp-journals-10071-24071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background and aims With the rise of coronavirus disease-2019 (COVID-19) cases globally, the infection among frontline healthcare workers (HCWs) escalates many folds. There is, however, limited literature from low middle-income countries regarding risk factors for COVID-19 infection in HCWs. We conducted a case–control study to evaluate the risk factors of COVID-19 infection to HCWs. Materials and methods This case–control study was conducted in a designated COVID-19 hospital. Eighty-one HCWs involved in direct care of COVID-19 patients, identified as cases, and 266 were recruited as controls. Telephonic interviews with participants were conducted, and information regarding demographic variables, chemoprophylaxis, exposure to infected patients, and adherence to infection prevention and control (IPC) measures was collected. Results We observed a statistically significant difference in the number of times training session for IPC measures attended by HCWs (p = 0.02), performance of aerosol-generating medical procedures (AGMPs) (p <0.001), practices of donning and doffing of personal protective equipment (PPE) (p <0.001), hand hygiene (p <0.001), and decontamination of highly touched surfaces (p <0.001). Logistic regression analysis revealed if the decontamination of highly touched surfaces is decreased by one unit, the odds of getting COVID-19 infection is multiplied by a factor of 0.41 and AGMPs decrease the risk of being a case by 0.76. Conclusion This study highlighted that inadequate observation of IPC methods increases the risk of COVID-19 infection to frontline HCWs, whereas performance of AGMPs does not enhance the risk. In this study, HCWs undertaking an AGMP, because of concern of acquiring infection, were more diligent during procedures and hence had lesser infection. How to cite this article Kerai S, Singh R, Saxena KN, Desai SD. Assessment of Risk Factors for Coronavirus Disease-2019 in Healthcare Workers: A Case–Control Study. Indian J Crit Care Med 2022;26(1):76–84.
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Affiliation(s)
- Sukhyanti Kerai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Rahil Singh
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
- Rahil Singh, Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India, Phone: +91 9810719025, e-mail:
| | - Kirti N Saxena
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Suraj D Desai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
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73
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Wang TP, Li HH, Lin HL. Positive Airway Pressure at Extubation Minimizes Subglottic Secretion Leak In Vitro. J Clin Med 2022; 11:jcm11020307. [PMID: 35054001 PMCID: PMC8778407 DOI: 10.3390/jcm11020307] [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: 10/15/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
Accumulated secretion above the endotracheal tube cuff can be aspirated during extubation after deflation. The possible techniques for minimizing pulmonary aspiration from subglottic secretion during extubation have not been well explored. This study aimed to determine the effect of different extubation techniques on secretion leakage. An endotracheal tube was placed in a tube mimicking an airway. We measured the leak volume of water or artificial sputum of different viscosities with three extubation techniques—negative pressure with suctioning; positive pressure with a resuscitator; and continuous positive airway pressure set at 5, 10, and 20 cm H2O. Extubation with continuous positive airway pressure resulted in lower secretion leakage than that with negative pressure with suctioning and positive pressure with a resuscitator. Increasing the continuous positive airway pressure level decreased secretion leakage volume during extubation. We further determined a correlation of leak volume with sputum viscosity. Continuous positive airway pressure at 5 cm H2O produced lower volume secretion leakage than the other two techniques, even with higher secretion viscosity. Based on these results, using continuous positive airway pressure with a previous ventilator continuous positive airway pressure/positive end-expiratory pressure setting for extubation is recommended.
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Affiliation(s)
- Tzu-Pei Wang
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Hsin-Hsien Li
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
- Correspondence: ; Tel.: +886-3-2118800 (ext. 5228)
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Kaur M, Sethi P, Kumari K, Bhatia P. Role of lignocaine in aerosol prevention during COVID-19: A new perspective. J Anaesthesiol Clin Pharmacol 2022; 38:S138-S139. [PMID: 36060180 PMCID: PMC9438821 DOI: 10.4103/joacp.joacp_690_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/14/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
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McGowan A, Laveneziana P, Bayat S, Beydon N, Boros P, Burgos F, Fležar M, Franczuk M, Galarza MA, Kendrick AH, Lombardi E, Makonga-Braaksma J, McCormack MC, Plantier L, Stanojevic S, Steenbruggen I, Thompson B, Coates AL, Wanger J, Cockcroft DW, Culver B, Sylvester K, De Jongh F. International consensus on lung function testing during the COVID-19 pandemic and beyond. ERJ Open Res 2022; 8:00602-2021. [PMID: 35261912 PMCID: PMC8607240 DOI: 10.1183/23120541.00602-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 10/31/2021] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function testing. Community prevalence, reoccurrence of COVID-19 surges and the emergence of different variants of SARS-CoV-2 have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance. This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond. Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups and alternative options to testing in hospitals. The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long-term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required.
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Affiliation(s)
- Aisling McGowan
- Dept of Respiratory and Sleep Diagnostics, Connolly Hospital, Dublin, Ireland
- School of Physics, Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP–Sorbonne Université, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Sam Bayat
- Centre Hospitalier Universitaire de Grenoble Alpes, Unité d'Explorations Fonctionnelles, Cardiorespiratoires, Grenoble, France
- Université Grenoble Alpes – INSERM UA7, Rayonnement Synchrotron pour la Recherche Biomédicale (STROBE), Grenoble, France
| | - Nicole Beydon
- Unité Fonctionnelle de Physiologie-Explorations Fonctionnelles Respiratoires, AP-HP Sorbonne Université, Hôpital Armand-Trousseau, Paris, France
| | - P.W. Boros
- Lung Pathophysiology Dept, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Felip Burgos
- Department of Pulmonary Medicine, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - Matjaž Fležar
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Monika Franczuk
- Lung Pathophysiology Dept, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Maria-Alejandra Galarza
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP–Sorbonne Université, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département R3S), Paris, France
| | - Adrian H. Kendrick
- Dept of Respiratory Medicine, University Hospitals Bristol & Weston NHS Trust, Bristol, UK
- University of West of England, Bristol, UK
- School of Physiology, Pharmacology and Neurophysiology, University of Bristol, Bristol, UK
| | - Enrico Lombardi
- Pediatric Pulmonary Unit, Anna Meyer Pediatric University Hospital, Florence, Italy
| | | | - Meredith C. McCormack
- Pulmonary Function Laboratory, Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Laurent Plantier
- Pulmonology and Lung Function Testing, CHRU de Tours, Tours, France
- University of Tours, CEPR/Inserm UMR1100, Tours, France
| | - Sanja Stanojevic
- Dept of Community Health and Epidemiology, Dalhousie University, New Brunswick, NS, Canada
| | | | - Bruce Thompson
- Faculty of Health, Arts and Design, Swinburne University of Technology, Victoria, Australia
| | - Allan L. Coates
- Division of Respiratory Medicine, Dept of Pediatrics, Physiology and Environmental Medicine, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jack Wanger
- Pulmonary Function Testing and Clinical Trial Consultant, Rochester, MN, USA
| | - Donald W. Cockcroft
- Division of Respirology, Critical Care and Sleep Medicine, Dept of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Bruce Culver
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Karl Sylvester
- Cambridge Respiratory Physiology, Cambridge University Hospital, Cambridge, UK
- Royal Papworth Hospital, Cambridge, UK
| | - Frans De Jongh
- Lung Function Lab, Medisch Spectrum Twente, Enschede, The Netherlands
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Calmet H, Bertomeu PF, McIntyre C, Rennie C, Gouder K, Houzeaux G, Fletcher C, Still R, Doorly D. Computational modelling of an aerosol extraction device for use in COVID-19 surgical tracheotomy. JOURNAL OF AEROSOL SCIENCE 2022; 159:105848. [PMID: 34334806 PMCID: PMC8314856 DOI: 10.1016/j.jaerosci.2021.105848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 05/02/2023]
Abstract
In view of the ongoing COVID-19 pandemic and its effects on global health, understanding and accurately modelling the propagation of human biological aerosols has become crucial. Worldwide, health professionals have been one of the most affected demographics, representing approximately 20% of all cases in Spain, 10% in Italy and 4% in China and US. Methods to contain and remove potentially infected aerosols during Aerosol Generating Procedures (AGPs) near source offer advantages in reducing the contamination of protective clothing and the surrounding theatre equipment and space. In this work we describe the application of computational fluid dynamics in assessing the performance of a prototype extraction hood as a means to contain a high speed aerosol jet. Whilst the particular prototype device is intended to be used during tracheotomies, which are increasingly common in the wake of COVID-19, the underlying physics can be adapted to design similar machines for other AGPs. Computational modelling aspect of this study was largely carried out by Barcelona Supercomputing Center using the high performance computational mechanics code Alya. Based on the high fidelity LES coupled with Lagrangian frameworks the results demonstrate high containment efficiency of generated particles is feasible with achievable air extraction rates.
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Affiliation(s)
- Hadrien Calmet
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Edificio NEXUS I, Gran Capitán 2-4, 08034 Barcelona, Spain
| | - Pablo Ferrer Bertomeu
- Imperial College London, Department of Aeronautics, Exhibition Road, London SW7 2AZ, UK
| | - Charlotte McIntyre
- Imperial College London, Department of Aeronautics, Exhibition Road, London SW7 2AZ, UK
| | - Catherine Rennie
- Imperial College London, Department of Aeronautics, Exhibition Road, London SW7 2AZ, UK
| | - Kevin Gouder
- Imperial College London, Department of Aeronautics, Exhibition Road, London SW7 2AZ, UK
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center (BSC-CNS), Department of Computer Applications in Science and Engineering, Edificio NEXUS I, Gran Capitán 2-4, 08034 Barcelona, Spain
| | | | - Robert Still
- Mercedes-AMG Petronas Formula One Team, Brackley, Northamptonshire, UK
| | - Denis Doorly
- Imperial College London, Department of Aeronautics, Exhibition Road, London SW7 2AZ, UK
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Laguardia GCDA, Püschel VADA, Oliveira PPD, Faria LRD, Cavalcante RB, Coelho ADCO, Santos KBD, Carbogim FDC. Controle de partículas aéreas nos procedimentos cirúrgicos durante a pandemia da Covid-19: revisão de escopo. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2021-0579pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: Mapear as estratégias técnicas e gerenciais para o manejo e a redução da produção de partículas aéreas em ambientes de procedimentos cirúrgicos durante a pandemia da Covid-19. Método: Revisão de escopo, de acordo com metodologia do Joana Briggs Institute, a partir de documentos indexados nas bases MEDLINE, BVS, CINAHL Cochrane, Embase, Scopus, Web of Science e literatura cinza, publicados em português, inglês ou espanhol. Foram considerados todos os estudos provenientes de periódicos científicos indexados e recomendações publicadas por órgãos internacionais ou associações acadêmicas, de 2019 a janeiro de 2022. Os achados foram sumarizados e analisados por estatística descritiva e síntese narrativa. Resultados: Foram selecionados 22 estudos, sendo 19 publicados em inglês, dois em espanhol, um em português, com predominância de revisões da literatura. Os achados foram categorizados em recomendações para o ambiente, a equipe e a técnica cirúrgica. Conclusão: a revisão mapeou as estratégias técnicas e gerenciais para o manejo e a redução da produção de partículas aéreas nos ambientes de procedimentos cirúrgicos. Envolvem desde o uso de equipamentos de proteção individual, treinamentos, modalidade anestésica, manipulação de vias aéreas, até a execução da técnica cirúrgica.
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Affiliation(s)
| | - Vilanice Alves de Araújo Püschel
- Universidade de São Paulo, Brazil; Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), Brazil
| | | | | | | | | | - Kelli Borges dos Santos
- Universidade Federal de Juiz de Fora, Brazil; Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), Brazil
| | - Fábio da Costa Carbogim
- Universidade Federal de Juiz de Fora, Brazil; Centro Brasileiro para o Cuidado à Saúde Baseado em Evidências: Centro de Excelência do JBI (JBI Brasil), Brazil
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78
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Manjit G, Girijanandan M, Sunitha Z, Lintu G, Linby C, Sruthy V. Study on airway assessment practices for elective procedures during pre-anesthetic evaluation in COVID-19 pandemic- A national online survey (SAFE PAC Survey). J Anaesthesiol Clin Pharmacol 2022; 38:S79-S88. [PMID: 36060175 PMCID: PMC9438836 DOI: 10.4103/joacp.joacp_138_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Aims: A pilot study among anesthesiologists, revealed a wide variation among individual practices including skipping pre-anesthetic airway assessment during COVID-19 pandemic because of the fear of getting infected. Risk of infection during pre-anesthetic airway assessment has not been studied. The primary objective of the survey was to evaluate the practices of airway examination by anesthesiologists during this pandemic period. Secondary objectives were to study the effects of institutional factors and other individual practices on risk modification and the incidence of COVID-19 infection among anesthesiologists. Material and Methods: A survey was conducted using a pre-validated questionnaire comprising of 35 questions. The questionnaire was circulated among 4676 members of the Indian Society of Anaesthesiologists (ISA) through Google Forms by email. Results: Of the 4676 members contacted via email, 470 were returned undelivered. From the remaining 4206 questionnaire recipients, 456 completed responses were obtained giving a response rate of 10.8%. Percentage, mean and standard deviation were calculated using EZR software. The conduct of pre-anesthetic airway assessment has decreased by 31.7% during the pandemic, leading to 5.2% of participants encountering unanticipated difficult airway. Among the respondents, eight percent were infected. Conclusion: Avoidance of preoperative airway assessment by anesthesiologists during the COVID-19 pandemic has led to rising unanticipated difficult airway undermining the patient safety. Adherence to recommended practices ensures safety from risk of COVID-19 infection.
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79
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Chea N, Brown CJ, Eure T, Ramirez RA, Blazek G, Penna AR, Li R, Czaja CA, Johnston H, Barter D, Miller BF, Angell K, Marshall KE, Fell A, Lovett S, Lim S, Lynfield R, Davis SS, Phipps EC, Sievers M, Dumyati G, Concannon C, McCullough K, Woods A, Seshadri S, Myers C, Pierce R, Ocampo VLS, Guzman-Cottrill JA, Escutia G, Samper M, Thompson ND, Magill SS, Grigg CT. Risk Factors for SARS-CoV-2 Infection Among US Healthcare Personnel, May-December 2020. Emerg Infect Dis 2022; 28:95-103. [PMID: 34856114 PMCID: PMC8714235 DOI: 10.3201/eid2801.211803] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine risk factors for coronavirus disease (COVID-19) among US healthcare personnel (HCP), we conducted a case-control analysis. We collected data about activities outside the workplace and COVID-19 patient care activities from HCP with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (cases) and from HCP with negative test results (controls) in healthcare facilities in 5 US states. We used conditional logistic regression to calculate adjusted matched odds ratios and 95% CIs for exposures. Among 345 cases and 622 controls, factors associated with risk were having close contact with persons with COVID-19 outside the workplace, having close contact with COVID-19 patients in the workplace, and assisting COVID-19 patients with activities of daily living. Protecting HCP from COVID-19 may require interventions that reduce their exposures outside the workplace and improve their ability to more safely assist COVID-19 patients with activities of daily living.
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80
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Chauhan V, Thakur S. State of the Globe: Protecting Health-Care Workers from Aerosolized Infections. J Glob Infect Dis 2022; 14:1-2. [PMID: 35418735 PMCID: PMC8996456 DOI: 10.4103/jgid.jgid_37_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivek Chauhan
- Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Suman Thakur
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Shrimpton AJ, Brown JM, Gregson FKA, Cook TM, Scott DA, McGain F, Humphries RS, Dhillon RS, Reid JP, Hamilton F, Bzdek BR, Pickering AE. Quantitative evaluation of aerosol generation during manual facemask ventilation. Anaesthesia 2022; 77:22-27. [PMID: 34700360 PMCID: PMC8653000 DOI: 10.1111/anae.15599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/13/2023]
Abstract
Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol-generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS-CoV-1 outbreak in 2003. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation and facemask ventilation with an intentionally generated leak in anaesthetised patients. Recordings were made in ultraclean operating theatres and compared against the aerosol generated by tidal breathing and cough manoeuvres. Respiratory aerosol from tidal breathing in 11 patients was reliably detected above the very low background particle concentrations with median [IQR (range)] particle counts of 191 (77-486 [4-1313]) and 2 (1-5 [0-13]) particles.l-1 , respectively, p = 0.002. The median (IQR [range]) aerosol concentration detected during facemask ventilation without a leak (3 (0-9 [0-43]) particles.l-1 ) and with an intentional leak (11 (7-26 [1-62]) particles.l-1 ) was 64-fold (p = 0.001) and 17-fold (p = 0.002) lower than that of tidal breathing, respectively. Median (IQR [range]) peak particle concentration during facemask ventilation both without a leak (60 (0-60 [0-120]) particles.l-1 ) and with a leak (120 (60-180 [60-480]) particles.l-1 ) were 20-fold (p = 0.002) and 10-fold (0.001) lower than a cough (1260 (800-3242 [100-3682]) particles.l-1 ), respectively. This study demonstrates that facemask ventilation, even when performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, we argue facemask ventilation should not be considered an aerosol-generating procedure.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | | | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospital NHS TrustBathUK
| | - D. A. Scott
- Department of Critical CareUniversity of Melbourne; St. Vincent's Hospital MelbourneAustralia
| | - F. McGain
- Western HealthFootscrayVictoriaAustralia
| | - R. S. Humphries
- Climate Science CentreCSIRO Oceans and AtmosphereAspendaleVictoriaAustralia
| | - R. S. Dhillon
- Department of NeurosurgerySt Vincent's Hospital MelbourneFitzroyVictoriaAustralia
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - F. Hamilton
- Department of Population Health SciencesUniversity of BristolBristolUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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82
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Evrard D, Jurcisin I, Assadi M, Patrier J, Tafani V, Ullmann N, Timsit JF, Montravers P, Barry B, Weiss E, Rozencwajg S. Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort. PLoS One 2021; 16:e0261024. [PMID: 34936655 PMCID: PMC8694414 DOI: 10.1371/journal.pone.0261024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. METHODS We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. RESULTS Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. CONCLUSIONS Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.
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Affiliation(s)
- Diane Evrard
- Department of Otorhinolaryngology, Bichat Hospital, Paris, France
| | - Igor Jurcisin
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Paris, France
| | - Maksud Assadi
- Department of Anesthesia and Surgical Intensive Care Unit, Bichat Hospital, Université de Paris, UFR Denis Diderot, INSERM UMR 1152, ANR10-LABX-17, Paris, France
| | | | - Victor Tafani
- Department of Otorhinolaryngology, Bichat Hospital, Paris, France
| | - Nicolas Ullmann
- Department of Oral and Maxillofacial surgery, Beaujon Hospital, Paris, France
| | | | - Philippe Montravers
- Department of Anesthesia and Surgical Intensive Care Unit, Bichat Hospital, Université de Paris, UFR Denis Diderot, INSERM UMR 1152, ANR10-LABX-17, Paris, France
| | - Béatrix Barry
- Department of Otorhinolaryngology, Bichat Hospital, Paris, France
| | - Emmanuel Weiss
- Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Paris, France
- Inserm UMR-S1149, Inserm et Université de Paris, Paris, France
| | - Sacha Rozencwajg
- Department of Anesthesia and Surgical Intensive Care Unit, Bichat Hospital, Université de Paris, UFR Denis Diderot, INSERM UMR 1152, ANR10-LABX-17, Paris, France
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83
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Hasegawa G, Sakai W, Chaki T, Tachibana S, Kokita A, Kato T, Nishimura H, Yamakage M. Investigations into the efficacy of a novel extubation-aerosol shield: a cough model study. Infect Prev Pract 2021; 4:100193. [PMID: 34901825 PMCID: PMC8642834 DOI: 10.1016/j.infpip.2021.100193] [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: 08/12/2021] [Accepted: 11/30/2021] [Indexed: 01/25/2023] Open
Abstract
Background Physicians have had to perform numerous extubation procedures during the prolonged coronavirus disease 2019 (COVID 19) pandemic. Future pandemics caused by unknown pathogen may also present a risk of exposure to infectious droplets and aerosols. Aim This study evaluated the ability of a newly developed aerosol barrier, “Extubation-Aerosol (EA)-Shield” to provide maximum protection from aerosol exposure during extubation via an aerosolised particle count and high-quality visualisation assessments. Methods We employed a cough model having parameters similar to humans and used micron oil aerosol as well as titanium dioxide as aerosol tracers. Aerosol barrier techniques employing a face mask (group M) and EA-Shield (group H) were compared. Findings The primary outcome was the difference in the number of particles contacting the physician's face before and after extubation. The maximum distances of aerosol dispersal after extubation were measured as the secondary outcomes. All aerosolised particles of the two tracers were significantly smaller in group H than in group M (p < 0.05). In addition, the sagittal and axial maximum distances and sagittal areas of aerosol dispersal for 3, 5, and 10 s after extubation were significantly smaller in group H than in group M (p < 0.05). Conclusion This model indicates that EA-Shield could be highly effective in reducing aerosol exposure during extubation. Therefore, we recommend using it as an aerosol barrier when an infectious aerosol risk is suspected.
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Affiliation(s)
- Gen Hasegawa
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Wataru Sakai
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomohiro Chaki
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shunsuke Tachibana
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Kokita
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Hidekazu Nishimura
- Virus Research Centre, Clinical Research Division, Sendai Medical Centre, Sendai, Japan
| | - Michiaki Yamakage
- Department of Anaesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan
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84
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Klompas M, Milton DK, Rhee C, Baker MA, Leekha S. Current Insights Into Respiratory Virus Transmission and Potential Implications for Infection Control Programs : A Narrative Review. Ann Intern Med 2021; 174:1710-1718. [PMID: 34748374 DOI: 10.7326/m21-2780] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Policies to prevent respiratory virus transmission in health care settings have traditionally divided organisms into Droplet versus Airborne categories. Droplet organisms (for example, influenza) are said to be transmitted via large respiratory secretions that rapidly fall to the ground within 1 to 2 meters and are adequately blocked by surgical masks. Airborne pathogens (for example, measles), by contrast, are transmitted by aerosols that are small enough and light enough to carry beyond 2 meters and to penetrate the gaps between masks and faces; health care workers are advised to wear N95 respirators and to place these patients in negative-pressure rooms. Respirators and negative-pressure rooms are also recommended when caring for patients with influenza or SARS-CoV-2 who are undergoing "aerosol-generating procedures," such as intubation. An increasing body of evidence, however, questions this framework. People routinely emit respiratory particles in a range of sizes, but most are aerosols, and most procedures do not generate meaningfully more aerosols than ordinary breathing, and far fewer than coughing, exercise, or labored breathing. Most transmission nonetheless occurs at close range because virus-laden aerosols are most concentrated at the source; they then diffuse and dilute with distance, making long-distance transmission rare in well-ventilated spaces. The primary risk factors for nosocomial transmission are community incidence rates, viral load, symptoms, proximity, duration of exposure, and poor ventilation. Failure to appreciate these factors may lead to underappreciation of some risks (for example, overestimation of the protection provided by medical masks, insufficient attention to ventilation) or misallocation of limited resources (for example, reserving N95 respirators and negative-pressure rooms only for aerosol-generating procedures or requiring negative-pressure rooms for all patients with SARS-CoV-2 infection regardless of stage of illness). Enhanced understanding of the factors governing respiratory pathogen transmission may inform the development of more effective policies to prevent nosocomial transmission of respiratory pathogens.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland (D.K.M.)
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (S.L.)
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85
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Shrimpton AJ, Gregson FKA, Brown JM, Cook TM, Bzdek BR, Hamilton F, Reid JP, Pickering AE. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia 2021; 76:1577-1584. [PMID: 34287820 DOI: 10.1111/anae.15542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Many guidelines consider supraglottic airway use to be an aerosol-generating procedure. This status requires increased levels of personal protective equipment, fallow time between cases and results in reduced operating theatre efficiency. Aerosol generation has never been quantitated during supraglottic airway use. To address this evidence gap, we conducted real-time aerosol monitoring (0.3-10-µm diameter) in ultraclean operating theatres during supraglottic airway insertion and removal. This showed very low background particle concentrations (median (IQR [range]) 1.6 (0-3.1 [0-4.0]) particles.l-1 ) against which the patient's tidal breathing produced a higher concentration of aerosol (4.0 (1.3-11.0 [0-44]) particles.l-1 , p = 0.048). The average aerosol concentration detected during supraglottic airway insertion (1.3 (1.0-4.2 [0-6.2]) particles.l-1 , n = 11), and removal (2.1 (0-17.5 [0-26.2]) particles.l-1 , n = 12) was no different to tidal breathing (p = 0.31 and p = 0.84, respectively). Comparison of supraglottic airway insertion and removal with a volitional cough (104 (66-169 [33-326]), n = 27), demonstrated that supraglottic airway insertion/removal sequences produced <4% of the aerosol compared with a single cough (p < 0.001). A transient aerosol increase was recorded during one complicated supraglottic airway insertion (which initially failed to provide a patent airway). Detailed analysis of this event showed an atypical particle size distribution and we subsequently identified multiple sources of non-respiratory aerosols that may be produced during airway management and can be considered as artefacts. These findings demonstrate supraglottic airway insertion/removal generates no more bio-aerosol than breathing and far less than a cough. This should inform the design of infection prevention strategies for anaesthetists and operating theatre staff caring for patients managed with supraglottic airways.
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Affiliation(s)
- A J Shrimpton
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - F K A Gregson
- School of Chemistry, University of Bristol, Bristol, UK
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - B R Bzdek
- School of Chemistry, University of Bristol, Bristol, UK
| | - F Hamilton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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86
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Benham-Hermetz J, Mitchell V. Safe tracheal extubation after general anaesthesia. BJA Educ 2021; 21:446-454. [PMID: 34840816 DOI: 10.1016/j.bjae.2021.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- J Benham-Hermetz
- University College London Hospitals NHS Foundation Trust, London, UK
| | - V Mitchell
- University College London Hospitals NHS Foundation Trust, London, UK
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87
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Bielski K, Szarpak A, Jaguszewski MJ, Kopiec T, Smereka J, Gasecka A, Wolak P, Nowak-Starz G, Chmielewski J, Rafique Z, Peacock FW, Szarpak L. The Influence of COVID-19 on Out-Hospital Cardiac Arrest Survival Outcomes: An Updated Systematic Review and Meta-Analysis. J Clin Med 2021; 10:5573. [PMID: 34884289 PMCID: PMC8658174 DOI: 10.3390/jcm10235573] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/11/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest (OHCA) is associated with poor prognosis. Because the COVID-19 pandemic may have impacted mortality and morbidity, both on an individual level and the health care system as a whole, our purpose was to determine rates of OHCA survival since the onset of the SARS-CoV2 pandemic. We conducted a systematic review and meta-analysis to evaluate the influence of COVID-19 on OHCA survival outcomes according to the PRISMA guidelines. We searched the literature using PubMed, Scopus, Web of Science and Cochrane Central Register for Controlled Trials databases from inception to September 2021 and identified 1775 potentially relevant studies, of which thirty-one articles totaling 88,188 patients were included in this meta-analysis. Prehospital return of spontaneous circulation (ROSC) in pre-COVID-19 and COVID-19 periods was 12.3% vs. 8.9%, respectively (OR = 1.40; 95%CI: 1.06-1.87; p < 0.001). Survival to hospital discharge in pre- vs. intra-COVID-19 periods was 11.5% vs. 8.2% (OR = 1.57; 95%CI: 1.37-1.79; p < 0.001). A similar dependency was observed in the case of survival to hospital discharge with the Cerebral Performance Category (CPC) 1-2 (6.7% vs. 4.0%; OR = 1.71; 95%CI: 1.35-2.15; p < 0.001), as well as in the 30-day survival rate (9.2% vs. 6.4%; OR = 1.63; 95%CI: 1.13-2.36; p = 0.009). In conclusion, prognosis of OHCA is usually poor and even worse during COVID-19.
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Affiliation(s)
- Karol Bielski
- Research Unit, Polonia University, 4/6 Pulaskiego Str., 42-200 Czestochowa, Poland;
- Provincial Emergency Medical Service Dispatcher, 22 Poznanska, 00-685 Warsaw, Poland
| | - Agnieszka Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, 12 Solidarnosci Av., 03-411 Warsaw, Poland;
| | - Miłosz Jaroslaw Jaguszewski
- 1st Department of Cardiology, Medical University of Gdansk, 3A Sklodowskiej-Curie Str., 80-210 Gdansk, Poland;
| | - Tomasz Kopiec
- First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; (T.K.); (A.G.)
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 6 Bartla Str., 52-443 Wroclaw, Poland;
- Research Unit, Polish Society of Disaster Medicine, P.O. Box 78, Raszyn, 05-090 Warsaw, Poland
| | - Aleksandra Gasecka
- First Chair and Department of Cardiology, Medical University of Warsaw, 1A Banacha Str., 02-097 Warsaw, Poland; (T.K.); (A.G.)
| | - Przemysław Wolak
- Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
| | - Grazyna Nowak-Starz
- Institute of Health Sciences, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
| | | | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA; (Z.R.); (F.W.P.)
| | - Frank William Peacock
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Ben Taub Hospital, 1504 Taub Loop, Houston, TX 77030, USA; (Z.R.); (F.W.P.)
| | - Lukasz Szarpak
- Institute of Medicine, Jan Kochanowski University of Kielce, 5 Zeromskiego Str., 25-369 Kielce, Poland;
- Research Unit, Maria Sklodowska-Curie Bialystok Oncology Center, 12 Ogrodowa Str., 15-027 Bialystok, Poland
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88
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Arnold DT, Hamilton FW, Moran E. Coughs and sneezes spread diseases: but do 'aerosol generating' procedures? Thorax 2021; 77:216-217. [PMID: 34759027 DOI: 10.1136/thoraxjnl-2021-218133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 12/29/2022]
Affiliation(s)
- David T Arnold
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Fergus W Hamilton
- MRC-IEU, University of Bristol, Bristol, UK.,Microbiology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Ed Moran
- Department of Infectious Disease, North Bristol NHS Trust, Bristol, UK
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89
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Kwak KH, Kim JK, Kwon KT, Yeo J. Infection prevention measures and outcomes for surgical patients during a coronavirus disease 2019 (COVID-19) outbreak in a tertiary hospital in Daegu, South Korea. Yeungnam Univ J Med 2021; 39:223-229. [PMID: 34736296 PMCID: PMC9273144 DOI: 10.12701/yujm.2021.01431] [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: 08/10/2021] [Accepted: 10/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background The first large coronavirus disease 2019 (COVID–19) outbreak outside China occurred in Daegu. In response, we developed infection prevention measures for surgical patients during the outbreak at our hospital and retrospectively reviewed the outcomes of COVID–19–related surgical patients. Methods We reviewed the medical records of 118 COVID–19–related surgical patients and monitored their clinical outcomes until March 31, 2021. We also interviewed healthcare workers who participated in their perioperative care at Kyungpook National University Chilgok Hospital. The perioperative management guidelines for COVID–19–related patients were prepared through multidisciplinary discussions, including the infection control department, surgical departments, and anesthesiology department before and during the COVID–19 outbreak. Results One standard operating room was temporarily converted to a negative-pressure room by increasing the exhaust air volume, creating a relative pressure of −11.3 Pa. The healthcare workers were equipped with personal protective equipment according to the patient's classification of the risk of COVID–19 transmission. The 118 COVID–19–related patients underwent emergent surgery in the negative–pressure room, including three COVID–19–confirmed patients and five COVID–19–exposed patients. Conclusion All surgeries of the COVID–19–related patients were performed without specific adverse events or perioperative COVID–19 transmission. Our experience setting up a negative–pressure operating room and conservative perioperative protocol to prevent COVID–19 transmission will help plan and execute infection control measures in the future.
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Affiliation(s)
- Kyung-Hwa Kwak
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jay Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jinseok Yeo
- Department of Anesthesiology and Pain Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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90
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Hamilton FW, Gregson FKA, Arnold DT, Sheikh S, Ward K, Brown J, Moran E, White C, Morley AJ, Bzdek BR, Reid JP, Maskell NA, Dodd JW. Aerosol emission from the respiratory tract: an analysis of aerosol generation from oxygen delivery systems. Thorax 2021; 77:276-282. [PMID: 34737195 PMCID: PMC8867281 DOI: 10.1136/thoraxjnl-2021-217577] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/17/2021] [Indexed: 11/05/2022]
Abstract
Introduction continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) provide enhanced oxygen delivery and respiratory support for patients with severe COVID-19. CPAP and HFNO are currently designated as aerosol-generating procedures despite limited high-quality experimental data. We aimed to characterise aerosol emission from HFNO and CPAP and compare with breathing, speaking and coughing. Materials and methods Healthy volunteers were recruited to breathe, speak and cough in ultra-clean, laminar flow theatres followed by using CPAP and HFNO. Aerosol emission was measured using two discrete methodologies, simultaneously. Hospitalised patients with COVID-19 had cough recorded using the same methodology on the infectious diseases ward. Results In healthy volunteers (n=25 subjects; 531 measures), CPAP (with exhalation port filter) produced less aerosol than breathing, speaking and coughing (even with large >50 L/min face mask leaks). Coughing was associated with the highest aerosol emissions of any recorded activity. HFNO was associated with aerosol emission, however, this was from the machine. Generated particles were small (<1 µm), passing from the machine through the patient and to the detector without coalescence with respiratory aerosol, thereby unlikely to carry viral particles. More aerosol was generated in cough from patients with COVID-19 (n=8) than volunteers. Conclusions In healthy volunteers, standard non-humidified CPAP is associated with less aerosol emission than breathing, speaking or coughing. Aerosol emission from the respiratory tract does not appear to be increased by HFNO. Although direct comparisons are complex, cough appears to be the main aerosol-generating risk out of all measured activities.
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Affiliation(s)
- Fergus W Hamilton
- Infection Science, North Bristol NHS Trust, Westbury on Trym, UK .,MRC Integrative Epidemiology Unit, Bristol, UK
| | - Florence K A Gregson
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - David T Arnold
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - Sadiyah Sheikh
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - Kirsty Ward
- Physiotherapy Department, North Bristol NHS Trust, Westbury on Trym, UK
| | - Jules Brown
- Anaesthetics and Intensive Care Department, North Bristol NHS Trust, Westbury on Trym, UK
| | - Ed Moran
- Infectious Diseases, North Bristol NHS Trust, Bristol, UK
| | - Carrie White
- Research and Development, North Bristol NHS Trust, Westbury on Trym, UK
| | - Anna J Morley
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | | | - Bryan R Bzdek
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - Jonathan P Reid
- Bristol Aerosol Research Centre, School of Chemistry, University of Bristol, Bristol, UK
| | - Nicholas A Maskell
- Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
| | - James William Dodd
- MRC Integrative Epidemiology Unit, Bristol, UK.,Academic Respiratory Unit, North Bristol NHS Trust, Westbury on Trym, UK
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91
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Wilson NM, Marks GB, Eckhardt A, Clarke AM, Young FP, Garden FL, Stewart W, Cook TM, Tovey ER. The effect of respiratory activity, non-invasive respiratory support and facemasks on aerosol generation and its relevance to COVID-19. Anaesthesia 2021; 76:1465-1474. [PMID: 33784793 PMCID: PMC8250912 DOI: 10.1111/anae.15475] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
Respirable aerosols (< 5 µm in diameter) present a high risk of SARS-CoV-2 transmission. Guidelines recommend using aerosol precautions during aerosol-generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min-1 to count and size-fractionate close to all exhaled particles (0.5-25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high-flow nasal oxygen and single or dual circuit non-invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6-fold during talking and 370.8-fold during coughing (p < 0.001). High-flow nasal oxygen 60 at l.min-1 increased particle counts 2.3-fold (p = 0.031) during quiet breathing. Single and dual circuit non-invasive respiratory therapy at 25/10 cm.H2 O with quiet breathing increased counts by 2.6-fold and 7.8-fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non-invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions.
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Affiliation(s)
- N. M. Wilson
- Department of Intensive Care MedicinePrince of Wales HospitalSydneyAustralia
- Department of AnaesthesiaRoyal Infirmary of EdinburghEdinburghUK
| | - G. B. Marks
- Department of Respiratory MedicineUniversity of New South WalesSydneyAustralia
| | - A. Eckhardt
- Department of Intensive Care MedicinePrince of Wales HospitalSydneyAustralia
| | - A. M. Clarke
- Department of Intensive CareRoyal Prince Alfred HospitalSydneyAustralia
| | - F. P. Young
- Department of Intensive Care MedicinePrince of Wales HospitalSydneyAustralia
| | | | - W. Stewart
- Department of Intensive Care MedicinePrince of Wales HospitalSydneyAustralia
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospitals NHS TrustBathUK
- Bristol Medical SchoolUniversity of BristolUK
| | - E. R. Tovey
- Woolcock Institute of Medical ResearchUniversity of SydneyAustralia
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92
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Raithel S, Fields KG, Wu Y, Yao D. Adoption of airway management guidelines during COVID-19 pandemic improved endotracheal intubation success. J Clin Anesth 2021; 76:110556. [PMID: 34695749 PMCID: PMC8511686 DOI: 10.1016/j.jclinane.2021.110556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Stephen Raithel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | - Yiran Wu
- Xuzhou Medical University, 209 Tongshan Lu, Xuzhou, Jiangsu 221004, China
| | - Dongdong Yao
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Department of Anesthesiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114, USA.
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93
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Dheda K, Charalambous S, Karat AS, von Delft A, Lalloo UG, van Zyl Smit R, Perumal R, Allwood BW, Esmail A, Wong ML, Duse AG, Richards G, Feldman C, Mer M, Nyamande K, Lalla U, Koegelenberg CFN, Venter F, Dawood H, Adams S, Ntusi NAB, van der Westhuizen HM, Moosa MYS, Martinson NA, Moultrie H, Nel J, Hausler H, Preiser W, Lasersohn L, Zar HJ, Churchyard GJ. A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i4.173. [PMID: 34734176 PMCID: PMC8545268 DOI: 10.7196/ajtccm.2021.v27i4.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/21/2022] Open
Abstract
SUMMARY Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. RECOMMENDATIONS Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of 'zero harm', aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections;the use of respirators that meet national and international manufacturing standards;evaluation of all respirators, at the least, by qualitative fit testing; andthe use of respirators as part of a 'package of care' in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential.
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Affiliation(s)
- K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for
the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - A S Karat
- TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A von Delft
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- TB Proof, South Africa
| | - U G Lalloo
- Gateway Private Hospital Medical Centre, Umhlanga Ridge, South Africa
- Durban International Clinical Research Site, Durban, South Africa
| | - R van Zyl Smit
- Division of Pulmonology and Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - R Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for
the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - A Esmail
- Clinical Trials Unit, University of Cape Town Lung Institute, South Africa
| | - M L Wong
- Division of Pulmonology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A G Duse
- Clinical Microbiology & Infectious Diseases, School of Pathology of the NHLS & University of the Witwatersrand, Johannesburg, South Africa
| | - G Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Feldman
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Mer
- Department of Medicine, Divisions of Pulmonology and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K Nyamande
- Department of Pulmonology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - U Lalla
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H Dawood
- Greys Hospital, Pietermaritzburg, South Africa
| | - S Adams
- Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - N A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - H-M van der Westhuizen
- TB Proof, South Africa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - M-Y S Moosa
- Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Southern African HIV Clinicians Society
| | - N A Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - H Moultrie
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Clinical Microbiology & Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - H Hausler
- TB HIV Care, Cape Town, South Africa
| | - W Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service Tygerberg, Cape Town,
South Africa
| | - L Lasersohn
- South African Society of Anaesthesiologists
- Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Critical Care, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - H J Zar
- Department of Paediatrics & Child Health, Red Cross Children’s Hospital and SAMRC Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - G J Churchyard
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
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94
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Klompas M, Rhee C. Aerosol Generation During Exercise: Implications for Preventing Viral Transmission In and Out of the Exercise Laboratory. Chest 2021; 160:1174-1176. [PMID: 34625166 PMCID: PMC8490916 DOI: 10.1016/j.chest.2021.05.065] [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: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
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95
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Microdebrider is less aerosol-generating than CO 2 laser and cold instruments in microlaryngoscopy. Eur Arch Otorhinolaryngol 2021; 279:825-834. [PMID: 34623498 PMCID: PMC8498765 DOI: 10.1007/s00405-021-07105-9] [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: 07/07/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
Objective COVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production. Methods We measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other. Results Thirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles. Conclusions Microdebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.
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96
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Patankar P, Mandour Y. Rapid sequence spinal anaesthesia: a technique reborn during the COVID-19 pandemic. Br J Hosp Med (Lond) 2021; 82:1-2. [PMID: 34726949 DOI: 10.12968/hmed.2021.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With the wish to reduce aerosol generation and the shorter time to anaesthetic readiness, this article discusses why rapid sequence spinal anaesthesia could be used in preference to general anaesthesia, for the benefit of both patients and staff during the COVID-19 pandemic.
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Affiliation(s)
- Pushkar Patankar
- Department of Anaesthesia, University College Hospital, London, UK
| | - Yasser Mandour
- Department of Anaesthesia, University College Hospital, London, UK
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97
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Stein ML, Park RS, Afshari A, Disma N, Fiadjoe JE, Matava CT, McNarry AF, von Ungern-Sternberg BS, Kovatsis PG, Peyton JM. Lessons from COVID-19: A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method. Paediatr Anaesth 2021; 31:1074-1088. [PMID: 34387013 DOI: 10.1111/pan.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The authors recognized a gap in existing guidelines and convened a modified Delphi process to address novel issues in pediatric difficult airway management raised by the COVID-19 pandemic. METHODS The Pediatric Difficult Intubation Collaborative, a working group of the Society for Pediatric Anesthesia, assembled an international panel to reach consensus recommendations on pediatric difficult airway management during the COVID-19 pandemic using a modified Delphi method. We reflect on the strengths and weaknesses of this process and ways care has changed as knowledge and experience have grown over the course of the pandemic. RECOMMENDATIONS In the setting of the COVID-19 pandemic, the Delphi panel recommends against moving away from the operating room solely for the purpose of having a negative pressure environment. The Delphi panel recommends supplying supplemental oxygen and using videolaryngoscopy during anticipated difficult airway management. Direct laryngoscopy is not recommended. If the patient meets extubation criteria, extubate in the OR, awake, at the end of the procedure. REFLECTION These recommendations remain valuable guidance in caring for children with anticipated difficult airways and infectious respiratory pathology when reviewed in light of our growing knowledge and experience with COVID-19. The panel initially recommended minimizing involvement of additional people and trainees and minimizing techniques associated with aerosolization of viral particles. The demonstrated effectiveness of PPE and vaccination at reducing the risk of exposure and infection to clinicians managing the airway makes these recommendations less relevant for COVID-19. They would likely be important initial steps in the face of novel respiratory viral pathogens. CONCLUSIONS The consensus process cannot and should not replace evidence-based guidelines; however, it is encouraging to see that the panel's recommendations have held up well as scientific knowledge and clinical experience have grown.
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Affiliation(s)
- Mary Lyn Stein
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond S Park
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Arash Afshari
- Department of Pediatric and Obstetric Anesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Nicola Disma
- Unit for Research and Innovation, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - John E Fiadjoe
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.,Team Perioperative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - Pete G Kovatsis
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - James M Peyton
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
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98
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Wilson J, Carson G, Fitzgerald S, Llewelyn MJ, Jenkins D, Parker S, Boies A, Thomas J, Sutcliffe K, Sowden AJ, O'Mara-Eves A, Stansfield C, Harriss E, Reilly J. Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review. J Hosp Infect 2021; 116:37-46. [PMID: 34245806 PMCID: PMC8264274 DOI: 10.1016/j.jhin.2021.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.
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Affiliation(s)
- J Wilson
- Richard Wells Research Centre, University of West London, London, UK.
| | - G Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Fitzgerald
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - M J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - D Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - A Boies
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - J Thomas
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - K Sutcliffe
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - A J Sowden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - A O'Mara-Eves
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - C Stansfield
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - E Harriss
- Bodleian Health Care Libraries, John Radcliffe Hospital, Oxford, UK
| | - J Reilly
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
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99
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Are surgical and non-operating room intervention safe in the COVID-19 pandemic? A retrospective study. Epidemiol Infect 2021; 149:e210. [PMID: 34526170 PMCID: PMC8485005 DOI: 10.1017/s0950268821002119] [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] [Indexed: 12/02/2022] Open
Abstract
Little is known about the impact of COVID-19 on the outcomes of patients undergoing surgery and intervention. This study was conducted between 20 March and 20 May 2020 in six hospitals in Istanbul, and aimed to investigate the effects of surgery and intervention on COVID-19 disease progression, intensive care (ICU) need, mortality and virus transmission to patients and healthcare workers. Patients were examined in three groups: group I underwent emergency surgery, group II had an emergency non-operating room intervention, and group III received inpatient COVID-19 treatment but did not have surgery or undergo intervention. Mortality rates, mechanical ventilation needs and rates of admission to the ICU were compared between the three groups. During this period, patient and healthcare worker transmissions were recorded. In total, 1273 surgical, 476 non-operating room intervention patients and 1884 COVID-19 inpatients were examined. The rate of ICU requirement among patients who had surgery was nearly twice that for inpatients and intervention patients, but there was no difference in mortality between the groups. The overall mortality rates were 2.3% in surgical patients, 3.3% in intervention patients and 3% in inpatients. COVID-19 polymerase chain reaction positivity among hospital workers was 2.4%. Only 3.3% of infected frontline healthcare workers were anaesthesiologists. No deaths occurred among infected healthcare workers. We conclude that emergency surgery and non-operating room interventions during the pandemic period do not increase postoperative mortality and can be performed with low transmission rates.
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100
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Fuchs A, Lanzi D, Beilstein CM, Riva T, Urman RD, Luedi MM, Braun M. Clinical recommendations for in-hospital airway management during aerosol-transmitting procedures in the setting of a viral pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:333-349. [PMID: 34511223 PMCID: PMC7723398 DOI: 10.1016/j.bpa.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Daniele Lanzi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Matthias Braun
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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