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Vieira FN, Masy V, LaRue RJ, Laengert SE, De Lannoy CF, Rodrigues A, Sklar MC, Lo N, Petrosoniak A, Rezende-Neto J, Brochard LJ. An Individual Barrier Enclosure Actively Removing Aerosols for Airborne Isolation: A Vacuum Tent. Respir Care 2024; 69:395-406. [PMID: 38538026 PMCID: PMC11108102 DOI: 10.4187/respcare.11094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Abstract
BACKGROUND Aerosol barrier enclosure systems have been designed to prevent airborne contamination, but their safety has been questioned. A vacuum tent was designed with active continuous suctioning to minimize risks of aerosol dispersion. We tested its efficacy, risk of rebreathing, and usability on a bench, in healthy volunteers, and in an ergonomic clinical assessment study. METHODS First, a manikin with airway connected to a breathing simulator was placed inside the vacuum tent to generate active breathing, cough, and CO2 production; high-flow nasal cannula (HFNC) was applied in the manikin's nares. Negative pressure was applied in the vacuum tent's apex port using wall suction. Fluorescent microparticles were aerosolized in the vacuum tent for qualitative assessment. To quantify particles inside and around vacuum tent (aerosol retention), an airtight aerosol chamber with aerosolized latex microparticles was used. The vacuum tent was tested on healthy volunteers breathing with and without HFNC. Last, its usability was assessed in 5 subjects by 5 different anesthesiologists for delivery of full anesthesia, including intubation and extubation. RESULTS The vacuum tent was adjusted until no leak was visualized using fluorescent particles. The efficacy in retaining microparticles was confirmed quantitatively. CO2 accumulation inside the vacuum tent showed an inverse correlation with the suction flow in all conditions (normal breathing and HFNC 30 or 60 L/min) in bench and healthy volunteers. Particle removal efficacy and safe breathing conditions (CO2, temperature) were reached when suctioning was at least 60 L/min or 20 L/min > HFNC flow. Five subjects were successfully intubated and anesthetized without ergonomic difficulties and with minimal interference with workflow and an excellent overall assessment by the anesthesiologists. CONCLUSIONS The vacuum tent effectively minimized aerosol dispersion. Its continuous suction system set at a high suction flow was crucial to avoid the spread of aerosol particles and CO2 rebreathing.
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Affiliation(s)
- Fernando N Vieira
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Veronique Masy
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ryan J LaRue
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Scott E Laengert
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Charles F De Lannoy
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Antenor Rodrigues
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Michael C Sklar
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nick Lo
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew Petrosoniak
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Joao Rezende-Neto
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laurent J Brochard
- Mr Vieira and Drs Rodrigues, Sklar, and Brochard are affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. Dr Masy is affiliated with Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; and Division of Pediatric Critical Care, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Messrs LaRue and Laengert and Dr de Lannoy are affiliated with McMaster University, Center of Excellence in Protective Equipment and Materials, Hamilton, Ontario, Canada; and McMaster University, Department of Chemical Engineering, Hamilton, Ontario, Canada. Dr Lo is affiliated with Department of Anesthesiology and Pain Service, St. Michael's Hospital, Toronto, Ontario, Canada. Dr Petrosoniak is affiliated with Emergency Physician and Trauma Team, St. Michael's and Department of Medicine, University of Toronto, Ontario, Canada. Dr Rezende-Neto is affiliated with Trauma and Acute Care General Surgery, Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
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