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Park MH, Sung KS, Kim JH, Myung J, Hong JY. Development and demonstration of the protective efficacy of a convertible respiratory barrier enclosure: a simulation study. Clin Exp Emerg Med 2024; 11:59-67. [PMID: 38018073 PMCID: PMC11009702 DOI: 10.15441/ceem.23.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/23/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The efficacy of previously developed respiratory barrier enclosures to limit healthcare workers' exposure to aerosols from COVID-19 patients remains unclear; in addition, the design of these devices is unsuitable for transportation or other emergency procedures. Therefore, we developed a novel negative pressure respiratory isolator to improve protection from patient-generated aerosols and evaluated its protective effect in conversion to systemic isolator. METHODS This in vitro study simulated droplets by nebulizing 1% glycerol + 99% ethanol solution. We performed cardiopulmonary resuscitation (CPR) and converted a respiratory barrier enclosure into a systemic isolator with a respiratory barrier as well as a respiratory barrier with negative pressure generator (NPG), which were compared with control and room air. During the procedure, particles were counted for 30 seconds and the count was repeated 10 times. RESULTS During CPR, the total number of particles in the respiratory barrier with NPG (280,529; interquartile range [IQR], 205,263-359,195; P=0.970) was similar to that in the control (308,789; IQR, 175,056-473,276). Using NPG with a respiratory barrier reduced the number of particles to 27,524 (IQR, 26,703- 28,905; P=0.001). Particle number during conversion of the respiratory barrier into a systemic isolator was also lower than in the control (25,845; IQR, 19,391- 29,772; P=0.001). CONCLUSION The novel isolator was converted to a systemic isolator without air leakage. The aerosol-blocking effect of the isolator was quantified using a particle counter during CPR. Further studies comparing the barrier effect of isolators within various pressure differentials are warranted.
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Affiliation(s)
- Min Ho Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Ji Hoon Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jinwoo Myung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Young Hong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Jang W, Kang H, Shin H, Kim C, Lee H, Choi H. Introduction of Infection Prevention Tracheal Intubation Protocol during the COVID-19 Pandemic Is Not Associated with First-Pass Success Rates of Endotracheal Intubation in the Emergency Department: A Before-and-After Comparative Study. J Pers Med 2023; 13:1017. [PMID: 37374006 DOI: 10.3390/jpm13061017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023] Open
Abstract
Aerosols and droplets have put healthcare workers performing airway management at high risk of contracting coronavirus disease 2019 (COVID-19). Experts have developed endotracheal intubation (ETI) guidelines and protocols to protect intubators from infection. We aimed to determine whether changes in the emergency department (ED) intubation protocol to prevent COVID-19 infection were associated with first-pass success (FPS) rates in ETI. We used data from the airway management registries in two academic EDs. The study was divided into pre-pandemic (January 2018 to January 2020) and pandemic (February 2020 to February 2022) periods. We selected 2476 intubation cases, including 1151 and 1325 cases recorded before and during the pandemic, respectively. During the pandemic, the FPS rate was 92.2%, which did not change significantly, and major complications increased slightly but not significantly compared with the pre-pandemic period. The OR for the FPS of applying infection prevention intubation protocols was 0.72 (p = 0.069) in a subgroup analysis, junior emergency physicians (PGY1 residents) had an FPS of less than 80% regardless of pandemic protocol implementation. The FPS rate of senior emergency physicians in physiologically difficult airways decreased significantly during the pandemic (98.0% to 88.5%). In conclusion, the FPS rate and complications for adult ETI performed by emergency physicians using COVID-19 infection prevention intubation protocols were similar to pre-pandemic conditions.
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Affiliation(s)
- Wooseok Jang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
| | - Hyukjoong Choi
- Department of Emergency Medicine, Hanyang University Guri Hospital, Guri 11923, Republic of Korea
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Jones RM, Andrus N, Dominguez T, Biggs J, Hansen B, Drews FA. Aerosol containment device design considerations and performance evaluation metrics. Am J Emerg Med 2023; 64:12-20. [PMID: 36435005 PMCID: PMC9650508 DOI: 10.1016/j.ajem.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated? METHODS A scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation. RESULTS Fifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance. CONCLUSION With respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience.
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Affiliation(s)
- Rachael M. Jones
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, United States of America,Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, United States of America,Corresponding author at: 650 Charles E Young Dr. S, 71-295, Center for Health Sciences, Los Angeles, CA 90095, United States of America
| | - Niles Andrus
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, United States of America
| | - Thomas Dominguez
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, United States of America
| | - Jeremy Biggs
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, United States of America
| | - Brian Hansen
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, United States of America
| | - Frank A. Drews
- Department of Psychology, College of Social and Behavioral Science, University of Utah, United States of America
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Mahmudiono T, Singhal S, Mohammad AA, Failoc-Rojas VE, Catalan Opulencia MJ, Haro AS, Salam Karim Y, Qurbonov N, Kamal Abdelbasset W, Mahdi AB, Fakri Mustafa Y. The impact of aerosol box on tracheal intubation during the COVID‐19 pandemic: a systematic review. Expert Rev Med Devices 2022; 19:779-789. [DOI: 10.1080/17434440.2022.2132149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Trias Mahmudiono
- Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Kota Surabaya, Indonesia
| | - Saurabh Singhal
- Department of Computer Engineering and Applications, GLA University, Mathura, Uttar Pradesh, India
| | | | | | | | | | | | - Nizom Qurbonov
- Department of DKTF Surgery, Endoscopy and Anesthesiology and Intensive Care, Samarkand State Medical Institute, Amir Temur Street 18, Samarkand, Uzbekistan
- Department of Scientific Affairs, Tashkent State Dental Institute, Makhtumkuli Street 103, Tashkent, 100047, Uzbekistan
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Ahmed B. Mahdi
- Anesthesia Techniques Department, Al-Mustaqbal University College, Babylon, Iraq
| | - Yasser Fakri Mustafa
- Department of Pharmaceutical Chemistry, College of Pharmacy, University of Mosul, Mosul-41001, Iraq
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Kaya AG, Öz M, Orhun İK, Erol S, Çiledağ A, Karnak D, Kaya A. A new device for bronchoscopy for better protection. Turk J Med Sci 2022; 52:361-369. [PMID: 36161605 PMCID: PMC10381228 DOI: 10.3906/sag-2109-258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 12/04/2021] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the risk of transmission of SARS-CoV-2 has not been precisely known in bronchoscopy procedures. We have designed a cabinet device called Ankara University Bronchoscopy Cabinet (Aubrocab®) to protect healthcare. We aimed to evaluate preventing effect of Aubrocab® on aerosol spreading by measuring the particles in the bronchoscopy suite. METHODS The patients were categorized into two groups as those who underwent bronchoscopy with and without Aubrocab®. We measured PM 0.5 levels before and after bronchoscopy in the bronchoscopy suite. RESULTS A total of 82 patients, 62 of whom underwent bronchoscopy with Aubrocab®, were enrolled in the study. The PM 0.5 level measured before bronchoscopy was similar in both groups, whereas the PM 0.5 level measured after bronchoscopy was lower in the Aubrocab® group (42,603 ± 8,632 vs. 50,377 ± 10,487, p = 0.001). The percent of particle change (50.76 ± 19.91 vs 67.15 ± 24.24, p = 0.003) and the difference of the particle numbers between pre and postprocedure (13,638 ± 4,292 and 19,501 ± 5,891, p < 0.001) were lower in the Aubrocab® group. DISCUSSION Our institution developed a barrier device named Aubrocab® which was shown to prevent excessive aerosol release in addition to routine precautions during bronchoscopy procedures.
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Affiliation(s)
- Aslıhan Gürün Kaya
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Miraç Öz
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Serhat Erol
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aydın Çiledağ
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Demet Karnak
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Akın Kaya
- Department of Chest Diseases, Faculty of Medicine, Ankara University, Ankara, Turkey
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Chen C, Shen N, Chen L, Luo T, Lu T, Liu D, Zhang Q, Hei Z. Application of a protective sleeve is associated with decreased occupational anxiety during endotracheal intubation: a randomized controlled trial. BMC Anesthesiol 2021; 21:251. [PMID: 34686149 PMCID: PMC8532101 DOI: 10.1186/s12871-021-01467-7] [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: 04/30/2021] [Accepted: 10/08/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The high risk of cross-infection during tracheal intubation has caused excessive occupational anxiety for anaesthesiologists amid the novel coronavirus disease 2019 (COVID-19) pandemic. Currently, there is no effective way to attenuate their anxiety in clinical practice. We found that anaesthesiologist with better protective equipment might experience decreased levels of anxiety during intubation. METHODS In this study, 60 patients who underwent intubation and extubation in the operating room were enrolled, and then randomized 1:1 to either wear protective sleeves (protective sleeve group) or not (control group). Visual analogue scale (VAS) was used to measure the anxiety level of anaesthesiologists during intubation. The respiratory droplets of patients on the sleeve, and the anaesthesiologists' perception including the patient's oral malodour, exertion, satisfaction degree, waist discomfort and shoulder discomfort were recorded. The patients' anxiety, oppressed feelings and hypoxia and postoperative complications were all measured and recorded. RESULTS Compared with the control group, the anaesthesiologists in protective sleeve group achieved lower anxiety scores and better satisfaction degrees during the process of intubation and extubation (all P < 0.05). Respiratory droplets were observed only on the inner side, but not the external side, of the protective sleeves (P < 0.001). The incidence of the anaesthesiologists' perception of patients' oral malodour was significantly lower in the protective sleeve group (P = 0.02) and no patients developed hypoxemia or intubation-related complications in the protective sleeve group. CONCLUSION Using protective devices for intubation might eliminate droplet transmission from patients to anaesthesiologists, while also decreasing their anxiety in a controlled operating room environment. TRIAL REGISTRATION Chinese Clinical Trial. no. ChiCTR2000030705 . Registry at www.chictr.org.cn on 10/03/2020.
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Affiliation(s)
- Chaojin Chen
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China
- Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital, Sun Yat-sen University, No.600 Tianhe Road, Guangzhou, People's Republic of China
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ning Shen
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Liubing Chen
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Tongsen Luo
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Tianyou Lu
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Dezhao Liu
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China
| | - Qi Zhang
- Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital, Sun Yat-sen University, No.600 Tianhe Road, Guangzhou, People's Republic of China.
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering, Ministry of Education, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Ziqing Hei
- Department of Anaesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, People's Republic of China.
- Department of Anaesthesiology, Yuedong Hospital, The Third Affiliated Hospital of Sun Yat-sen University, Meizhou, People's Republic of China.
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Ganann MG, Kitila M, Patel R, Brook CD, Pisegna JM. The FEES box: A novel barrier to contain particles during aerosol-generating procedures. Am J Otolaryngol 2021; 42:102888. [PMID: 33460980 PMCID: PMC7834572 DOI: 10.1016/j.amjoto.2020.102888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/27/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Due to the COVID-19 pandemic, aerosol-generating procedures (AGPs) such as flexible endoscopic evaluation of swallowing (FEES) have been deemed high-risk and in some cases restricted, indicating the need for additional personal protective equipment. The aim of this study was to erect and study a protective barrier for FEES. MATERIALS AND METHODS A PVC cube was constructed to fit over a patient while allowing for upright endoscopy. A plastic drape was fitted over the cube, and the protective barrier was subsequently named the "FEES Box." Three different particulate-generating tasks were carried out: sneezing, coughing, and spraying water from an atomizer bottle. Each task was completed within and without the FEES Box, and particulate was measured with a particle counter. The average particles/L detected during the three tasks, and baseline measurements, were statistically compared. RESULTS Without the FEES Box in place, the sneezing and spraying tasks resulted in a statistically significant increase in particles above baseline (p < 0.001 and p = 0.004, respectively); coughing particulate never reached levels significantly higher than baseline (p = 0.230). With use of the FEES Box, there was no statistically significant increase in particles above baseline in any of the three tasks. CONCLUSION The FEES Box effectively contained particles generated during sneezes and an atomizer spray. It would also likely mitigate coughing particulate, but coughing did not generate a significant increase in particles above baseline. Further research is warranted to test the efficacy of the FEES Box in containing particulate matter during a complete FEES procedure.
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Affiliation(s)
- Michelle G Ganann
- Voice and Swallowing Center, Boston Medical Center, Boston, MA, United States.
| | - Merertu Kitila
- Voice and Swallowing Center, Boston Medical Center, Boston, MA, United States
| | - Ravi Patel
- Boston University School of Medicine, Boston, MA, United States
| | - Christopher D Brook
- Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Boston University, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States
| | - Jessica M Pisegna
- Voice and Swallowing Center, Boston Medical Center, Boston, MA, United States; Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Boston University, Boston, MA, United States
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