Intensive care unit isolation hood decreases risk of aerosolization during noninvasive ventilation with COVID-19
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CORRESPONDENCE
Intensive care unit isolation hood decreases risk of aerosolization during noninvasive ventilation with COVID-19 Kendrick M. Shaw, MD PhD . Angela L. Lang, MD . Rodrigo Lozano . Michele Szabo, MD . Samuel Smith, MD . Jingping Wang, MD PhD
Received: 12 May 2020 / Revised: 15 May 2020 / Accepted: 15 May 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, The treatment of patients with coronavirus disease (COVID-19) needs to take into consideration not only the disease process but also the availability of medical resources and the risks of transmission to healthcare providers. Noninvasive ventilation (NIV) and oxygenation with high-flow nasal cannula (HFNC) are considered by many to be a high-risk aerosol-generating procedure.1 As such, their use is typically avoided in our institution, with mechanical ventilation being the preferred means of respiratory support in patients with COVID-19associated respiratory failure. On a national level, however, the ventilator shortage may necessitate a shift towards NIV and HFNC to ease the pressure on scarce ventilator resources.2 The use of HFNC was widely employed in China3 and it is also recommended by the European Society of Intensive Care Medicine.4 Although there is no direct evidence in patients with COVID-19, HFNC has been shown to reduce the risk of intubation in patients with acute hypoxic respiratory failure compared with conventional oxygen therapy.5 To explore the possibility of safely using HFNC in COVID-19 patients, we developed a custom-built intensive care unit isolation hood (ICUIH)
Kendrick M. Shaw and Angela L. Lang have contributed equally to the study. K. M. Shaw, MD PhD A. L. Lang, MD M. Szabo, MD S. Smith, MD J. Wang, MD PhD (&) Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA e-mail: [email protected] R. Lozano Department of Biomedical Engineering, Massachusetts General Hospital, Boston, MA, USA
with the intent to minimize contamination risk from potential aerosols generated with HFNC. The ICUIH is disposable and can provide a negative pressure environment to contain aerosols when used with a smoke plume evacuator (VisiclearÒ; Buffalo Filter, Lancaster, NY, USA) or other suction source. For testing, a humidifier (JB07; Jisulife, Shenzhen, China) was used for continuous aerosol generation in the ICUIH. The HFNC (air/oxygen blender - Micromax; Maxtec, Salt Lake City, UT, USA; flow meter - Blender Buddy 1; Maxtec, Salt Lake City, UT, USA; HFNC: 1600HF-7-25; Salter Labs, Lake Forest, IL, USA) was placed close to the humidifier outlet, and delivered oxygen at a rate of 70 Lmin-1 (Figure, panel A). A laser particle counter (PMS5003; Plantower, Beijing, China) was placed inside the hood on the simulated patient’s head and a second laser particle counter was placed outside the hood at approximately head position of a provider. In many cases, the particle count inside the hood exceeded the range of the particle counter for particles between 0.3 and 0.5 lm so th
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