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Emergency management plan for paediatric patients with tracheostomies during the coronavirus disease 2019 pandemic. The Journal of Laryngology & Otology 2022; 136:1289-1295. [DOI: 10.1017/s0022215122001591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objectives
Paediatric patients with tracheostomies are a vulnerable group. During the coronavirus disease 2019 pandemic, healthcare workers can be anxious about viral transmission from secretions and aerosols emerging from the open airway. This paper aims to share a systematic approach to decrease staff exposure and optimise care of these patients.
Methods
Three documents were developed: a generic tracheostomy management plan detailing troubleshooting; a personalised management plan with customised recommendations; and a guide for tracheostomy tube change to minimise aerosol production.
Results
The plan was distributed to 31 patients (age range, 11 months to 17 years) including 23 (74.2 per cent) with uncuffed tubes and 9 (29 per cent) on long-term ventilation. There have been 10 occasions in which the plan was utilised and influenced management.
Conclusion
A structured approach to emergency presentations during the coronavirus disease 2019 pandemic may safeguard paediatric patients from unnecessary manipulation of their tracheostomy tube, minimise viral exposure and allow provision of expeditious care.
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Johns M, Kyaw S, Lim R, Stewart WC, Thambiraj SR, Shehabi Y, Collins DW, Whyte CM, Arora S. Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles. Indian J Crit Care Med 2021; 25:981-986. [PMID: 34963714 PMCID: PMC8664035 DOI: 10.5005/jp-journals-10071-23972] [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: 01/17/2023] Open
Abstract
N95 respirators and safety goggles are important components of personal protective equipment to reduce the spread of airborne infections, such as COVID-19, among healthcare workers. Poor N95 respirator seal may reduce its protective effect, thereby increasing transmission. Quantitative fit testing is an established way of assessing the N95 respirator fit, which provides a quantitative measure for seal, called the fit factor. Duckbill N95 respirators frequently fail the fit test. We hypothesized that using safety goggles with a wraparound elastic headband will increase their fit-factor by reinforcing the seal between the face and the upper margin of the respirator. We studied the effect of safety goggles with a wraparound elastic headband (3M™ Chemical Splash Resistant Goggles, ID 70006982741) on the fit factor of two types of Duckbill N95 respirators (Halyard FLUIDSHIELD*3, Model 99SA070M, and ProShield® N95 Model TN01-11) in 63 healthy volunteers in a nonrandomized, before-and-after intervention study design. The mean fit factor increased from 69.4 to 169.1 increased from 17/63 (27%) to 46/63 (73%) after the intervention (p <0.0001, OR 3 [95% CI = 4.9–1223]). This is the first study to explore the impact of safety goggles on N95 respirator fit. We conclude that the use of safety goggles with a wraparound elastic headband increases the fit factor of the tested Duckbill N95 respirators.
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Affiliation(s)
- Moira Johns
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sandy Kyaw
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Rimen Lim
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Warren C Stewart
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Solomon R Thambiraj
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Yahya Shehabi
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - David W Collins
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Claudia M Whyte
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sumesh Arora
- Department of Intensive Care Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
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