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Computational modelling of an aerosol extraction device for use in COVID-19 surgical tracheotomy.

ABSTRACT: In view of the ongoing COVID-19 pandemic and its effects on global health, understanding and accurately modelling the propagation of human biological aerosols has become crucial. Worldwide, health professionals have been one of the most affected demographics, representing approximately 20% of all cases in Spain, 10% in Italy and 4% in China and US. Methods to contain and remove potentially infected aerosols during Aerosol Generating Procedures (AGPs) near source offer advantages in reducing the contamination of protective clothing and the surrounding theatre equipment and space. In this work we describe the application of computational fluid dynamics in assessing the performance of a prototype extraction hood as a means to contain a high speed aerosol jet. Whilst the particular prototype device is intended to be used during tracheotomies, which are increasingly common in the wake of COVID-19, the underlying physics can be adapted to design similar machines for other AGPs. Computational modelling aspect of this study was largely carried out by Barcelona Supercomputing Center using the high performance computational mechanics code Alya. Based on the high fidelity LES coupled with Lagrangian frameworks the results demonstrate high containment efficiency of generated particles is feasible with achievable air extraction rates.

SUBMITTER: Calmet H

PROVIDER: S-EPMC8314856 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceWhile telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic.ObjectiveTo assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic.Design, setting, and participantsInsurance claims from a Michigan statewide commercial payer for new patient visits with a surgeon from 1 of 9 surgical specialties during one of the following periods: prior to the COVID-19 pandemic (period 1: January 5 to March 7, 2020), early pandemic (period 2: March 8 to June 6, 2020), and late pandemic (period 3: June 7 to September 5, 2020).ExposuresTelehealth implementation owing to the COVID-19 pandemic in March 2020.Main outcomes and measures(1) Conversion rate defined as the rate of weekly new patient telehealth visits divided by mean weekly number of total new patient visits in 2019. This outcome adjusts for a substantial decrease in outpatient care during the pandemic. (2) Weekly number of new patient telehealth visits divided by weekly number of total new patient visits.ResultsAmong 4405 surgeons in the cohort, 2588 (58.8%) performed telehealth in any patient care context. Specifically for new patient visits, 1182 surgeons (26.8%) used telehealth. A total of 109 610 surgical new outpatient visits were identified during the pandemic. The median (interquartile range) age of telehealth patients was 46.8 (34.1-58.4) years compared with 52.6 (38.3-62.3) years for patients who received care in-person. Prior to March 2020, less than 1% (8 of 173 939) of new patient visits were conducted through telehealth. Telehealth use peaked in April 2020 (week 14) and facilitated 34.6% (479 of 1383) of all new patient visits during that week. The telehealth conversion rate peaked in April 2020 (week 15) and was equal to 8.2% of the 2019 mean weekly new patient visit volume. During period 2, a mean (SD) of 16.6% (12.0%) of all new patient surgical visits were conducted via telehealth (conversion rate of 5.1% of 2019 mean weekly new patient visit volumes). During period 3, 3.0% (2168 of 71 819) of all new patient surgical visits were conducted via telehealth (conversion rate of 2.5% of 2019 new patient visit volumes). Mean (SD) telehealth conversion rates varied by specialty with urology being the highest (14.3% [7.7%]).Conclusions and relevanceResults from this study showed that telehealth use grew across all surgical specialties in Michigan in response to the COVID-19 pandemic. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic.

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Computational modelling of an aerosol extraction device for use in COVID-19 surgical tracheotomy.

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