The COVID-19 Airway Management Isolation Chamber (CAMIC) for Ears.
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ABSTRACT:
SUBMITTER: Tolisano AM
PROVIDER: S-EPMC7361893 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient's body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.
| S-EPMC7453071 | biostudies-literature
Project description: Not available
| S-EPMC7937356 | biostudies-literature
Project description:Importance:The COVID-19 pandemic is characterized by high transmissibility from patients with prolonged minimally- or asymptomatic periods, with a particularly increased risk of spread during aerosol-generating procedures, including endotracheal intubation. Observations:All patients presenting with upper airway obstruction due to angioedema during this time should be carefully managed in a way that is safest for both patient and provider. Conclusions:For patients requiring emergent airway management during the COVID-19 pandemic, minimization of aerosols while taking the necessary precautions to protect healthcare workers should are critical principles for their management.
| S-EPMC7274586 | biostudies-literature
Project description: Not available
| S-EPMC7200124 | biostudies-literature
Project description:BackgroundDuring the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have also occurred to other non-COVID-infected patients in the Emergency Department (ED).MethodsA retrospective analytic study was conducted in the ED of Siriraj Hospital, Bangkok, Thailand, including adult patients presenting with signs and symptoms of respiratory distress between 1 March and 30 April 2020 (the COVID period). A comparison group using the same inclusion criteria was retrieved from 1 March to 30 April 2019 (the pre-COVID period). The primary outcome was rate of NIV and HFNC use. The secondary outcomes were rate of intubation, failure of NIV and HFNC, complications, and mortality.ResultsA total of 360 and 333 patients were included during the pre-COVID and COVID periods, respectively. After adjusting for baseline differences, patients in the COVID period were less likely to receive either NIV or HFNC than the pre-COVID period (adjusted OR 0.52 [95%CI 0.29-0.92]). Overall, intubation rate was similar between the two study periods. However, patients in respiratory distress with pulmonary edema had a relatively higher intubation rate in the COVID period. There were higher failure rates of NIV and HFNC, more infectious complications, and a higher rate of mortality in the pre-COVID period.ConclusionDuring the COVID-19 pandemic, the overall usage of NIV and HFNC in emergency non-COVID patients decreased. Although not affecting the overall intubation rate, this change of practice could have affected some groups of patients. Therefore, treatment decisions based on a balance between the benefits to the patients and the safety of healthcare providers should be made.
| S-EPMC8397873 | biostudies-literature
Project description:The whole world at present is dealing with the COVID 19 pandemic. As per studies worldwide SARS-CoV-2 by sequencing analysis is 95% homogenous similar to the bat coronavirus and almost 70% similar to the SARS-CoV-1. SARS CoV 2 is a respiratory problem which in its worst form of disease causes ARDS and hampers the patient's ability to breathe on his own and has to be put on Ventilator. As per WHO (World Health Organization) guidelines, sanitization is an effective way of prevention from the infection. The proper sanitization being not feasible and time consuming in certain cases, faster and effective alternatives of sanitization processes are necessary. As per recently published study by researchers in Beijing, China, it was observed that with each degree rise in temperature and percent humidity, the contagiousness of the disease caused by the Coronavirus, named COVID 19 goes down significantly. R-naught or RO can be referred as the average number of people that gets infected from one sick person among a population which is not immune to the virus. The closer to zero an RO value the better the results indicating less spread of the disease. A lower RO means the outbreak is slowing or declining while a higher one means its swelling or growing at faster rate. The RO of the coronavirus hovers between 2 and 2.5 as per World Health Organization or WHO meaning that each new person spreads the disease to about 2.2 people on an average. The chamber being developed is aimed at lowering the Ro value so that the infection rate slows down. RO is not a fixed value, it changes depending on various factors such as proximity among people, the environmental surroundings and climatic conditions. The higher temperatures (38 °C) at 80-90% relative humidity decreases the virus activity within 24 h. Moreover, in a condition where the virus that was dried was stored at higher temperature (>38 °C) and high relative humidity (>95%), there was observed an additional degradation in virus activity at each point in time. Taking into consideration the above research, we developed a COVID De-Incubator chamber to disinfect the clothes and commonly used daily wear items. Our results were exciting as the disinfection proved to be effective at temperatures of 75 °C-80 °C and humidity levels at 80%-90%. Moreover, the chamber was developed at significantly lower costs. In this study, an attempt has been made to fabricate a chamber with temperature and humidity-controlled environment to disinfect daily used material. Using fins and momentum source, a homogenous environment is created inside the chamber for better results, with the help of numerical simulation to decide the optimum angle for the inclination of fins and location of the momentum source.
| S-EPMC7591299 | biostudies-literature
Project description:A previously healthy 42-year-old male developed a fever and cough shortly after returning to Canada from overseas. Initially, he had mild upper respiratory tract infection symptoms and a cough. He was aware of the coronavirus disease-2019 (COVID-19) and the advisory to self-isolate and did so; however, he developed increasing respiratory distress over several days and called 911. On arrival at the emergency department (ED), his heart rate was 130 beats/min, respiratory rate 32 per/min, and oxygenation saturation 82% on room air. As per emergency medical services (EMS) protocol, they placed him on nasal prongs under a surgical mask at 5 L/min and his oxygen saturation improved to 86%.
| S-EPMC7203167 | biostudies-literature
Project description: Not available
| S-EPMC7283688 | biostudies-literature
Project description:Objective Children's hospitals frequently care for infants with various life-threatening airway anomalies. Management of these infants can be challenging given unique airway anatomy and potential malformations. Airway emergency management must be immediate and precise, often demanding specialized equipment and/or expertise. We developed a Neonatal-Infant Airway Safety Program to improve medical responses, communication, equipment usage and outcomes for infants requiring emergent airway interventions. Patients and Methods All patients admitted to our quaternary neonatal and infant intensive care unit (NICU) from 2008-2019 were included in this study. Our program consisted of a multidisciplinary airway response team, pager system, and emergency equipment cart. Respiratory therapists present at each emergency event recorded specialist response times, equipment utilization, and outcomes. A multidisciplinary oversite committee reviewed each incident. Results Since 2008, there were 159 airway emergency events in our NICU (~12 per year). Mean specialist response times decreased from 5.9±4.9 min (2008-2012, mean±SD) to 4.3±2.2 min (2016-2019, p=0.12), and the number of incidents with response times >5 min decreased from 28.8±17.8% (2008-2012) to 9.3±11.4% (2016-2019, p=0.04 by linear regression). As our program became more standardized, we noted better equipment availability and subspecialist communication. Few emergency situations (n=9, 6%) required operating room management. There were 3 patient deaths (2%). Conclusions Our airway safety program, including readily available specialists and equipment, facilitated effective resolution of airway emergencies in our NICU and multidisciplinary involvement enabled rapid and effective changes in response to COVID-19 regulations. A similar program could be implemented in other centers.
| S-EPMC7523164 | biostudies-literature
Project description:BackgroundTracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors.MethodsThe authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success.ResultsSuccessful first-attempt tracheal intubation was achieved in 4,017/4,476 (89.7%) episodes, while 23 of 4,476 (0.5%) episodes required four or more attempts. Ten emergency surgical airways were reported-an approximate incidence of 1 in 450 (10 of 4,476). Failed intubation (defined as emergency surgical airway, four or more attempts, or a supraglottic airway as the final device) occurred in approximately 1 of 120 episodes (36 of 4,476). Successful first attempt was more likely during rapid sequence induction versus non-rapid sequence induction (adjusted odds ratio, 1.89 [95% CI, 1.49 to 2.39]; P < 0.001), when operators used powered air-purifying respirators versus nonpowered respirators (adjusted odds ratio, 1.60 [95% CI, 1.16 to 2.20]; P = 0.006), and when performed by operators with more COVID-19 intubations recorded (adjusted odds ratio, 1.03 for each additional previous intubation [95% CI, 1.01 to 1.06]; P = 0.015). Intubations performed in low- or middle-income countries were less likely to be successful at first attempt than in high-income countries (adjusted odds ratio, 0.57 [95% CI, 0.41 to 0.79]; P = 0.001).ConclusionsThe authors report rates of failed tracheal intubation and emergency surgical airway in patients with COVID-19 requiring emergency airway management, and identified factors associated with increased success. Risks of tracheal intubation failure and success should be considered when managing COVID-19.Editor’s perspective
| S-EPMC8274456 | biostudies-literature