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Terheggen U, Heiring C, Kjellberg M, Hegardt F, Kneyber M, Gente M, Roehr CC, Jourdain G, Tissieres P, Ramnarayan P, Breindahl M, van den Berg J. European consensus recommendations for neonatal and paediatric retrievals of positive or suspected COVID-19 patients. Pediatr Res 2021; 89:1094-1100. [PMID: 32634819 DOI: 10.1038/s41390-020-1050-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The 2020 novel coronavirus (SARS-Cov-2) pandemic necessitates tailored recommendations addressing specific procedures for neonatal and paediatric transport of suspected or positive COVID-19 patients. The aim of this consensus statement is to define guidelines for safe clinical care for children needing inter-facility transport while making sure that the clinical teams involved are sufficiently protected from SARS-CoV-2. METHODS A taskforce, composed of members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) Transport section and the European Society for Paediatric Research (ESPR), reviewed the published literature and used a rapid, two-step modified Delphi process to formulate recommendations regarding safety and clinical management during transport of COVID-19 patients. RESULTS The joint taskforce consisted of a panel of 12 experts who reached an agreement on a set of 17 recommendations specifying pertinent aspects on neonatal and paediatric COVID-19 patient transport. These included: case definition, personal protective equipment, airway management, equipment and strategies for invasive and non-invasive ventilation, special considerations for incubator and open stretcher transports, parents on transport and decontamination of transport vehicles. CONCLUSIONS Our consensus recommendations aim to define current best-practice and should help guide transport teams dealing with infants and children with COVID-19 to work safely and effectively. IMPACT We present European consensus recommendations on pertinent measures for transporting infants and children in times of the coronavirus (SARS-Cov-2 /COVID-19) pandemic. A panel of experts reviewed the evidence around transporting infants and children with proven or suspected COVID-19. Specific guidance on aspects of personal protective equipment, airway management and considerations for incubator and open stretcher transports is presented. Based on scant evidence, best-practice recommendations for neonatal and paediatric transport teams are presented, aiming for the protection of teams and patients. We highlight gaps in knowledge and areas of future research.
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Affiliation(s)
- Ulrich Terheggen
- Department of Critical Care, Paediatric and Cardiac Intensive Care Unit, Al Jalila Children's Hospital, Dubai, United Arab Emirates.
| | - Christian Heiring
- Department of Neonatal and Paediatric Intensive Care, Rigshospitalet, the National University Hospital in Denmark, Copenhagen, Denmark
| | - Mattias Kjellberg
- Department of Neonatal Intensive Care, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Fredrik Hegardt
- Department of Pediatrics, Neonatal Intensive Care Unit, Umeå University Hospital, Umeå, Sweden
| | - Martin Kneyber
- Department of Paediatrics, Division of Paediatric Critical Care Medicine, Beatrix Children's Hospital, University, Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Critical Care, Anaesthesiology, Peri-Operative & Emergency Medicine (CAPE), University of Groningen, Groningen, The Netherlands
| | - Maurizio Gente
- Maternal Infant Department, Policlinico Umberto I, Sapienza University of Roma, Roma, Italy
| | - Charles C Roehr
- National Perinatal Epidemiology Unit Clinical Trials Unit, Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK.,Newborn Services, Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Gilles Jourdain
- Division of Pediatrics, Neonatal Critical Care and Transportation, Medical Center "A.Béclère", Paris Saclay University Hospitals, APHP, Paris, France
| | - Pierre Tissieres
- Pediatric Intensive Care Unit, Bicêtre University Hospital, AP-HP, Paris Saclay University, Le Kremlin-Bicêtre, France.,Integrative Biology of the Cell, CNRS, CEA, Paris South University, Paris Saclay University, Gif-sur-Yvette, France
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital, London, UK.,Paediatric Intensive Care Unit, St Mary's Hospital, London, UK
| | - Morten Breindahl
- Department of Neonatal and Paediatric Intensive Care, Rigshospitalet, the National University Hospital in Denmark, Copenhagen, Denmark
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2
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Suresh V. Airborne Infections and Emergency Surgery: The COVID-19 Pandemic Perspective. J Indian Assoc Pediatr Surg 2021; 26:76-88. [PMID: 34083889 PMCID: PMC8152406 DOI: 10.4103/jiaps.jiaps_99_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/09/2020] [Accepted: 05/16/2020] [Indexed: 12/14/2022] Open
Abstract
COVID-19 which emerged in Wuhan, China has rapidly spread all over the globe and the World Health Organisation has declared it a pandemic. COVID-19 disease severity shows variation depending on demographic characteristics like age, history of chronic illnesses such as cardio-vascular/renal/respiratory disease; pregnancy; immune-suppression; angiotensin converting enzyme inhibitor medication use; NSAID use etc but the pattern of disease spread is uniform - human to human through contact, droplets and fomites. Up to 3.5% of health care workers treating COVID-19 contact an infection themselves with 14.8% of these infections severe and 0.3% fatal. The situation has spread panic even among health care professionals and the cry for safe patient care practices are resonated world-wide. Surgeons, anesthesiologists and intensivists who very frequently perform endotracheal intubation, tracheostomy, non-invasive ventilation and manual ventilation before intubation are at a higher odds ratio of 6.6, 4.2, 3.1 and 2.8 respectively of contacting an infection themselves. Elective surgery is almost always deferred in fever/infection scenarios. A surgeon and an anesthesiologist can anytime encounter a situation where in a COVID-19 patient requires an emergency surgery. COVID-19 cases requiring surgery predispose anesthesiologists and surgeons to cross-infection threats. This paper discusses, the COVID-19 precautionary outlines which has to be followed in the operating room; personal protective strategies available at present; methods to raise psychological preparedness of medical professionals during a pandemic; conduct of anesthesia in COVID-19 cases/suspect cases; methods of decontamination after conducting a surgery for COVID-19 case in the operating room; and post-exposure prophylaxis for medical professionals.
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Affiliation(s)
- Varun Suresh
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
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3
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Chakhalian D, Shultz RB, Miles CE, Kohn J. Opportunities for biomaterials to address the challenges of COVID-19. J Biomed Mater Res A 2020; 108:1974-1990. [PMID: 32662571 PMCID: PMC7405498 DOI: 10.1002/jbm.a.37059] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has revealed major shortcomings in our ability to mitigate transmission of infectious viral disease and provide treatment to patients, resulting in a public health crisis. Within months of the first reported case in China, the virus has spread worldwide at an unprecedented rate. COVID-19 illustrates that the biomaterials community was engaged in significant research efforts against bacteria and fungi with relatively little effort devoted to viruses. Accordingly, biomaterials scientists and engineers will have to participate in multidisciplinary antiviral research over the coming years. Although tissue engineering and regenerative medicine have historically dominated the field of biomaterials, current research holds promise for providing transformative solutions to viral outbreaks. To facilitate collaboration, it is imperative to establish a mutual language and adequate understanding between clinicians, industry partners, and research scientists. In this article, clinical perspectives are shared to clearly define emerging healthcare needs that can be met by biomaterials solutions. Strategies and opportunities for novel biomaterials intervention spanning diagnostics, treatment strategies, vaccines, and virus-deactivating surface coatings are discussed. Ultimately this review serves as a call for the biomaterials community to become a leading contributor to the prevention and management of the current and future viral outbreaks.
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Affiliation(s)
- Daniel Chakhalian
- Department of Chemistry and Chemical BiologyRutgers – The State University of New JerseyPiscatawayNew JerseyUSA
| | - Robert B. Shultz
- Department of Chemistry and Chemical BiologyRutgers – The State University of New JerseyPiscatawayNew JerseyUSA
- Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of BioengineeringUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Catherine E. Miles
- Department of Chemistry and Chemical BiologyRutgers – The State University of New JerseyPiscatawayNew JerseyUSA
| | - Joachim Kohn
- Department of Chemistry and Chemical BiologyRutgers – The State University of New JerseyPiscatawayNew JerseyUSA
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4
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Sarrió-Sanz P, Martínez-Cayuelas L, Valencia-Guadalajara VJ, Villada-Warrington T, Sánchez-Caballero L, Nakdali-Kassab B, Gómez-Pérez L. An accessible and economical evacuation system for surgical fumes and pneumoperitoneum in laparoscopy during the SARS-CoV-2 pandemic. THE BRITISH JOURNAL OF SURGERY 2020; 107:e559-e560. [PMID: 32866297 PMCID: PMC7929130 DOI: 10.1002/bjs.11824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Pau Sarrió-Sanz
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
| | - Laura Martínez-Cayuelas
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
| | - Victor José Valencia-Guadalajara
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
| | - Tatiana Villada-Warrington
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
| | - Laura Sánchez-Caballero
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
| | - Baraa Nakdali-Kassab
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
| | - Luis Gómez-Pérez
- Hospital Universitario San Juan de Alicante, Carretera Nacional 332 Alicante-Valencia. S/n. CP 03550, San Juan de Alicante, Alicante, Spain
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5
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Abstract
The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.
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6
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Meng L, Qiu H, Wan L, Ai Y, Xue Z, Guo Q, Deshpande R, Zhang L, Meng J, Tong C, Liu H, Xiong L. Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan's Experience. Anesthesiology 2020; 132:1317-1332. [PMID: 32195705 PMCID: PMC7155908 DOI: 10.1097/aln.0000000000003296] [Citation(s) in RCA: 382] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/06/2020] [Indexed: 02/06/2023]
Abstract
The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.
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Affiliation(s)
- Lingzhong Meng
- From the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (L.M., R.D.) the Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (H.Q.) the Department of Anesthesiology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, China (L.W.) the Departments of Critical Care Medicine (Y.A., L.Z.) Anesthesiology (Q.G.) Respiratory Medicine (J.M.), Xiangya Hospital, Central South University, Changsha, Hunan Province, China the Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China (Z.X.) the Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina (C.T.) the Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California (H.L.) the Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People's Hospital, Tongji University School of Medicine, Shanghai, China (L.X.)
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7
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Goh KJ, Wong J, Tien JCC, Ng SY, Duu Wen S, Phua GC, Leong CKL. Preparing your intensive care unit for the COVID-19 pandemic: practical considerations and strategies. Crit Care 2020; 24:215. [PMID: 32393325 PMCID: PMC7213774 DOI: 10.1186/s13054-020-02916-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) has rapidly evolved into a worldwide pandemic. Preparing intensive care units (ICU) is an integral part of any pandemic response. In this review, we discuss the key principles and strategies for ICU preparedness. We also describe our initial outbreak measures and share some of the challenges faced. To achieve sustainable ICU services, we propose the need to 1) prepare and implement rapid identification and isolation protocols, and a surge in ICU bed capacity; (2) provide a sustainable workforce with a focus on infection control; (3) ensure adequate supplies to equip ICUs and protect healthcare workers; and (4) maintain quality clinical management, as well as effective communication.
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Affiliation(s)
- Ken Junyang Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Jolin Wong
- Division of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | | | - Shin Yi Ng
- Division of Anaesthesiology, Singapore General Hospital, Singapore, Singapore
| | - Sewa Duu Wen
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Ghee Chee Phua
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Carrie Kah-Lai Leong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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8
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Yeo D, Kaushal S, Ahmed S. Clearing the air: an accessible system for suction and safe evacuation of pneumoperitoneum during laparoscopy in patients with COVID-19. Br J Surg 2020; 107:e200. [PMID: 32379342 PMCID: PMC7267272 DOI: 10.1002/bjs.11683] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/21/2022]
Affiliation(s)
- D Yeo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - S Kaushal
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - S Ahmed
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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9
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Ling L, Joynt GM, Lipman J, Constantin JM, Joannes-Boyau O. COVID-19: A critical care perspective informed by lessons learnt from other viral epidemics. Anaesth Crit Care Pain Med 2020; 39:163-166. [PMID: 32088344 PMCID: PMC7119083 DOI: 10.1016/j.accpm.2020.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China.
| | - Jeff Lipman
- Intensive Care Services, Royal Brisbane and Women's Hospital; The University of Queensland Centre for Clinical Research, Brisbane, Australia; Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Jean-Michel Constantin
- Medecine Sorbonne-Université, DMU DREAM, AP-HP Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France; GRC ARPE, Medecine Sorbonne-Université, Paris, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000, Bordeaux, France
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10
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He Y, Wei J, Bian J, Guo K, Lu J, Mei W, Ma J, Xia Z, Xu M, Yan F, Yu C, Wang E, Wang W, Zeng N, Wang S, Xu J, Huang Y, Huang J. Chinese Society of Anesthesiology Expert Consensus on Anesthetic Management of Cardiac Surgical Patients With Suspected or Confirmed Coronavirus Disease 2019. J Cardiothorac Vasc Anesth 2020; 34:1397-1401. [PMID: 32268984 PMCID: PMC7138179 DOI: 10.1053/j.jvca.2020.03.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/08/2023]
Abstract
The outbreak of a new coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) in China in December 2019 has brought serious challenges to disease prevention and public health. Patients with severe coronavirus disease 2019 (COVID-19) who undergo cardiovascular surgery necessitate extremely high demands from anesthesia personnel, and face high risks of mortality and morbidity. Based on the current understanding of COVID-19 and the clinical characteristics of cardiovascular surgical patients, the authors provide anesthesia management guidelines for cardiovascular surgery along with the prevention and control of COVID-19.
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Affiliation(s)
- Yi He
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Jinjun Bian
- Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Kefang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiakai Lu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Ma
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Meiying Xu
- Department of Anesthesiology, Shanghai Chest Hospital of Shanghai Jiaotong University, Shanghai, China
| | - Fuxia Yan
- Department of Anesthesiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunhua Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - E Wang
- Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weijian Wang
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ni Zeng
- Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China; Department of Anesthesiology, Linzhi People's Hospital, Linzhi, Tibet, China.
| | - Junmei Xu
- Department of Anesthesiology, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
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11
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Burman S, Sharma PB, Tyagi M, Singh GP, Chaturvedi A. Transport Circuit during COVID-19 Crisis: A Simple Modification of the Bain's Circuit for Safety of Healthcare Workers. Indian J Crit Care Med 2020; 24:1281-1283. [PMID: 33446988 PMCID: PMC7775932 DOI: 10.5005/jp-journals-10071-23686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Burman S, Sharma PB, Tyagi M, Singh GP, Chaturvedi A. Transport Circuit during COVID-19 Crisis: A Simple Modification of the Bain's Circuit for Safety of Healthcare Workers. Indian J Crit Care Med 2020;24(12):1281–1283.
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Affiliation(s)
- Sourav Burman
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep B Sharma
- Department of Anaesthesiology, Military Hospital (Kirkee), Pune, Maharashtra, India
| | - Mayank Tyagi
- Department of Neuroanaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder P Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Chaturvedi
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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12
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Davis JW, Pillow JJ, Cooper MN, Dahl MJ. Electrostatic Filters to Reduce COVID-19 Spread in Bubble CPAP: An in vitro Study of Safety and Efficacy. Neonatology 2020; 117:736-741. [PMID: 33249414 PMCID: PMC7801988 DOI: 10.1159/000512146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bubble CPAP may be used in infants with suspected or confirmed COVID-19. Electrostatic filters may reduce cross infection. This study aims to determine if including a filter in the bubble CPAP circuit impacts stability of pressure delivery. METHODS A new electrostatic filter was placed before (pre) or after (post) the bubble CPAP generator, or with no filter (control) in an in vitro study. Pressure was recorded at the nasal interface for 18 h (6 L/min; 7 cm H2O) on 3 occasions for each configuration. Filter failure was defined as pressure >9 cm H2O for 60 continuous minutes. The filter was weighed before and after each experiment. RESULTS Mean (SD) time to reach the fail point was 257 (116) min and 525 (566) min for filter placement pre- and post-CPAP generator, respectively. Mean pressure was higher throughout in the pre-generator position compared to control. The filter weight was heavier at end study in the pre- compared to the post-generator position. CONCLUSIONS Placement of the filter at the pre-generator position in a bubble CPAP circuit should be avoided due to unstable mean pressure. Filters are likely to become saturated with water over time. The post-generator position may accommodate a filter, but regular pressure monitoring and early replacement are required.
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Affiliation(s)
- Jonathan W Davis
- Neonatology, Child and Adolescent Health Service, Hospital Avenue, Nedlands, Washington, Australia, .,Medical School, The University of Western Australia, Perth, Washington, Australia,
| | - J Jane Pillow
- School of Human Sciences, The University of Western Australia, Perth, Washington, Australia
| | - Matthew N Cooper
- Biometrics, Telethon Kids Institute, University of Western Australia, Nedlands, Washington, Australia
| | - Mar Janna Dahl
- School of Human Sciences, The University of Western Australia, Perth, Washington, Australia
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13
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A novel sampling method to detect airborne influenza and other respiratory viruses in mechanically ventilated patients: a feasibility study. Ann Intensive Care 2018; 8:45. [PMID: 29666961 PMCID: PMC5904094 DOI: 10.1186/s13613-018-0396-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/12/2018] [Indexed: 02/05/2023] Open
Abstract
Background Respiratory viruses circulate constantly in the ambient air. The risk of opportunistic infection from these viruses can be increased in mechanically ventilated patients. The present study evaluates the feasibility of detecting airborne respiratory viruses in mechanically ventilated patients using a novel sample collection method involving ventilator filters. Methods We collected inspiratory and expiratory filters from the ventilator circuits of mechanically ventilated patients in an intensive care unit over a 14-month period. To evaluate whether we could detect respiratory viruses collected in these filters, we performed a reverse transcription polymerase chain reaction on the extracted filter membrane with primers specific for rhinovirus, respiratory syncytial virus, influenza virus A and B, parainfluenza virus (type 1, 2 and 3) and human metapneumovirus. For each patient, we also performed a full virology screen (virus particles, antibody titres and virus-induced biomarkers) on respiratory samples (nasopharyngeal swab, tracheal aspirate or bronchoalveolar fluid) and blood samples. Results Respiratory viruses were detected in the ventilator filters of nearly half the patients in the study cohort (n = 33/70). The most common virus detected was influenza A virus (n = 29). There were more viruses detected in the inspiratory filters (n = 18) than in the expiratory filters (n = 15). A third of the patients with a positive virus detection in the ventilator filters had a hospital laboratory confirmed viral infection. In the remaining cases, the detected viruses were different from viruses already identified in the same patient, suggesting that these additional viruses come from the ambient air or from cross-contamination (staff or visitors). In patients in whom new viruses were detected in the ventilator filters, there was no evidence of clinical signs of an active viral infection. Additionally, the levels of virus-induced biomarker in these patients were not statistically different from those of non-infected patients (p = 0.33). Conclusions Respiratory viruses were present within the ventilator circuits of patients receiving mechanical ventilation. Although no adverse clinical effect was evident in these patients, further studies are warranted, given the small sample size of the study and the recognition that ventilated patients are potentially susceptible to opportunistic infection from airborne respiratory viruses. Electronic supplementary material The online version of this article (10.1186/s13613-018-0396-4) contains supplementary material, which is available to authorized users.
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Joob B, Wiwanitkit V. Level of respiratory protection against influenza virus. GMS HYGIENE AND INFECTION CONTROL 2013; 8:Doc14. [PMID: 24327940 PMCID: PMC3850231 DOI: 10.3205/dgkh000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Beuy Joob
- Sanitation 1 Medical Academic Center, Bangkok, Thailand,*To whom correspondence should be addressed: Beuy Joob, Sanitation 1 Medical Academic Center, Bangkok, Thailand, E-mail:
| | - Viroj Wiwanitkit
- Hainan Medical University, Haikou, China,Faculty of Medicine, University of Nis, Serbia
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