Potential risks associated with intensive care unit aerosol isolation hood use
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CORRESPONDENCE
Potential risks associated with intensive care unit aerosol isolation hood use Betul Basaran, MD, DESA
. Aysun Ankay Yilbas, MD
Received: 31 May 2020 / Revised: 2 June 2020 / Accepted: 3 June 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, We read with interest the recent article by Shaw et al. using an isolation hood to limit the risk of aerosol spread during non-invasive ventilation (NIV) in the intensive care unit.1 Although they showed a reduction in aerosols within the hood during their simulation, after the clinical use of such an isolation hood, the process of removing and disposing of its plastic sheet may increase the risk of viral contamination despite the relative negative pressure environment created within it. As the authors indicated, the use of NIV and oxygenation with high-flow nasal cannula (HFNC) are advised during early periods of respiratory failure in the management of critically ill coronavirus disease patients.2 However, some patients who do not respond to these non-invasive treatment methods may eventually require intubation at a time when they are even more hypoxic and hemodynamically unstable. Any barrier protective measure may interfere with the crisis management of these unstable patients, which could be compounded if the physicians are faced with a difficult intubation or aspiration of stomach contents. Furthermore, an early awake prone position3 combined with HFNC or NIV would be an added challenge if the patient needs intubation while using this isolation hood. Therefore, until testing of the safety and efficacy of this isolation hood device can be carried out through well-designed
simulation-based or clinical studies, a more balanced approach may be needed between reducing environmental contamination (for the protection of healthcare workers) and managing critically ill patients safely. Disclosures
None.
Funding statement
None.
Editorial responsibility This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.
References 1. Shaw KM, Lang AL, Lozano R, Szabo M, Smith S, Wang J. Intensive care unit isolation hood decreases risk of aerosolization during noninvasive ventilation with COVID-19. Can J Anesth 2020; DOI: https://doi.org/10.1007/s12630-020-01721-5. 2. Alhazzani W, Moller MH, Arabi YM, et al. Surviving Sepsis Campaign: guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020; 46: 854-87. 3. Slessarev M, Cheng J, Ondrejicka M, Arntfield R, Critical Care Western Research Group. Patient self-proning with high-flow nasal cannula improves oxygenation in COVID-19 pneumonia. Can J Anesth 2020; DOI: https://doi.org/10.1007/s12630-02001661-0. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
B. Basaran, MD, DESA (&) Department of Anesthesiology, Konya Training and Research Hospital, Konya, Turkey e-mail: [email protected] A. Ankay Yilbas, MD Departm
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