1
|
Regli A, Litton E, Palermo A, Hammond N, Knowles S, von Ungern-Sternberg BS. Airborne personal protective equipment availability and preparedness in Australian and New Zealand intensive care units: A point prevalence survey. Aust Crit Care 2025; 38:101163. [PMID: 39884067 DOI: 10.1016/j.aucc.2024.101163] [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: 05/18/2024] [Revised: 12/10/2024] [Accepted: 12/10/2024] [Indexed: 02/01/2025] Open
Abstract
BACKGROUND Personal protective equipment is essential to protect healthcare workers when exposed to aerosol-generating procedures in patients with airborne respiratory pathogens. AIM This study aimed to provide information regarding the level of airborne protection offered to nursing staff and other healthcare workers in Australian and New Zealand intensive care units (ICUs) 1 year into the coronavirus disease 2019 pandemic. METHODS In this cross-sectional survey, ICUs in Australia and New Zealand were asked to participate in the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program in June 2021. Sites were asked to contribute to questions regarding airborne protection offered to nursing staff and other healthcare workers. RESULTS There were 51 participating sites. Negative-pressure bed space availability within participating ICUs included 24 with more than two, 15 with two, eight with one, and one ICU that did not have any. The median (interquartile range) number of different models and sizes of N95/P2 masks available to ICU staff was 6 (4-7). Of the 1018 nursing staff working that day in the units, 799 (78.5%) had at least one fit-tested N95/P2 mask in the correct size available. A total of 712 patients (461 medical and 251 surgical) were cared for by 700 bedside nurses in these ICUs. Overall, adequate airborne protection preparedness (airborne personal protective equipment training and fit-testing since the pandemic) was present in 548 (78.3%) bedside nurses. CONCLUSIONS Over a year into the coronavirus disease 2019 pandemic, airborne protection provided to nursing and other healthcare staff in Australia and New Zealand was often inadequate.
Collapse
Affiliation(s)
- Adrian Regli
- Intensive Care Unit, SJOG Murdoch Hospital, Murdoch, WA, Australia; Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Nedlands, WA, Australia; Medical School, The University of Notre Dame, Fremantle, WA, Australia.
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Nedlands, WA, Australia; Intensive Care Unit, SJOG Subiaco Hospital, Subiaco, WA, Australia
| | - Annemarie Palermo
- Intensive Care Unit, SJOG Murdoch Hospital, Murdoch, WA, Australia; Intensive Care Unit, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Naomi Hammond
- Critical Care Program, The George Institute for Global Health and UNSW Sydney, Barangaroo NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Serena Knowles
- Critical Care Program, The George Institute for Global Health and UNSW Sydney, Barangaroo NSW, Australia
| | - Britta Sylvia von Ungern-Sternberg
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia; Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, WA, Australia
| |
Collapse
|
2
|
Di Pietra G, Munegato D, Poletto C, Conciatori V, Di Sopra S, Franchin E, Castagliuolo I, Salata C, Del Vecchio C. Surveillance of influenza viruses circulating from 2017/2018 to 2023/2024 seasons in Veneto Region, North-East Italy. Virol J 2025; 22:114. [PMID: 40269941 PMCID: PMC12020185 DOI: 10.1186/s12985-025-02723-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 04/03/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND In Italy, influenza viruses typically circulate from October to April, causing seasonal epidemics. The pattern of influenza virus circulation varies each season regarding the timing of the first case notification, period of circulation, and predominant influenza virus types and subtypes. METHODS This analysis used comprehensive data from the national influenza surveillance network for the 2017/2018 to 2023/2024 influenza seasons in the Veneto Region. Influenza A (IAV) and B (IBV) viruses were detected and subtyped using real-time reverse transcriptase-polymerase chain reaction assays. RESULTS Of 21,180 oropharyngeal swabs collected from 2017 to 2024, 4,325 (20.42%) were positive for influenza viruses. IAV accounted for 78.68% of positive cases overall, representing more than 65% of cases in every season except 2017/2018 (26.72%). Both A(H1N1)pdm09 and A(H3N2) subtypes were detected in all seasons with varying proportions. IBV represented 21.32% of all positive cases, with Victoria and Yamagata lineages detected simultaneously during the 2017/2018 season. No Yamagata lineage was detected after the 2018/2019 season, and no IBV cases were detected in the 2021/2022 season. In almost all seasons, influenza virus circulation was more significant in adults, especially those 65 years and older, than in children. CONCLUSIONS In the Veneto Region, influenza virus circulation varied considerably from 2017/2018 to 2023/2024. In the 2020/2021 season, no influenza-positive samples were detected due to circulation of SARS-CoV-2 and related countermeasures. IAVs were the predominant type in most seasons, while IBVs made a limited contribution to the overall disease burden.
Collapse
Affiliation(s)
- Giuseppe Di Pietra
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
| | - Denis Munegato
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
| | - Chiara Poletto
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
| | - Valeria Conciatori
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
| | - Sarah Di Sopra
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
| | - Elisa Franchin
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, 35128, Padua, Italy
| | - Ignazio Castagliuolo
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, 35128, Padua, Italy
| | - Cristiano Salata
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy.
| | - Claudia Del Vecchio
- Department of Molecular Medicine, University of Padua, Via Gabelli 63, 35121, Padua, Italy.
- Microbiology and Virology Diagnostic Unit, Padua University Hospital, Via Giustiniani 2, 35128, Padua, Italy.
| |
Collapse
|
3
|
Wang Y, Ma W, Yang Y, Zhao H, Zhao Z, Zhao X. Research on Dynamic Outpatient Respiratory Nosocomial Infection Control Methods Through Multi-Data Prediction. Risk Manag Healthc Policy 2025; 18:1323-1332. [PMID: 40255879 PMCID: PMC12009034 DOI: 10.2147/rmhp.s508760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 03/28/2025] [Indexed: 04/22/2025] Open
Abstract
Objective This study aimed to develop a dynamic prevention and control method for fluctuating respiratory nosocomial infections in outpatients. Methods Six sets of surveillance data such as influenza-like case counts and their predicted results were used in the autoregressive integrated moving average model (ARIMA) to forecast the onset and end time points of the epidemic peak. A Delphi process was then used to build consensus on hierarchical infection control measures for epidemic peaks and plateaus. The data, predicted results, and hierarchical infection control measures can assist dynamic prevention and control of respiratory nosocomial infections with changes in the infection risk. Results The ARIMA model produced exact estimates. The mean absolute percentage errors (MAPE) of the data selected to estimate the time range of the high-risk and low-risk periods were 15.8%, 9.2%, 15.4%, 16.8%, 25.6%. The hierarchical infection control measures included three categories and nine key points. A risk-period judgment matrix was also designed to connect the surveillance data and the hierarchical infection control measures. Conclusion Through a mathematical model, dynamic prevention and control of respiratory tract infections in outpatients was constructed based on the daily medical service monitoring data of hospitals. It is foreseeable that when applied in medical institutions, this method will provide accurate and low-cost infection prevention and control outcomes.
Collapse
Affiliation(s)
- Yuncong Wang
- Hospital Infection Management Division, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Wenhui Ma
- Hospital Infection Management Division, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Yang Yang
- Hospital Infection Management Division, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Huijie Zhao
- Hospital Infection Management Division, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Zhongjing Zhao
- Hospital Infection Management Division, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Xia Zhao
- Hospital Infection Management Division, Xuanwu Hospital Capital Medical University, Beijing, People’s Republic of China
| |
Collapse
|
4
|
Elander L, Abdirashid A, Andersson H, Idh J, Johansson H, Chew MS. Frequency and outcomes of critically ill COVID-19 patients with tracheostomy, a retrospective two-center cohort study. Acta Anaesthesiol Scand 2025; 69:e70011. [PMID: 40103328 DOI: 10.1111/aas.70011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND The optimal use of tracheostomy in COVID-19 patients is debated, and considerable uncertainties on the frequency, timing, and outcomes of tracheostomy remain. The objective was to study the frequency and timing of tracheostomy in a real-world population of critically ill COVID-19 patients. The secondary aim was to study whether early tracheostomy was associated with days alive and out of intensive care unit (ICU), days free of invasive mechanical ventilation (IMV), 60-day mortality, ventilator weaning rate, and ICU discharge rate compared to late tracheostomy. METHODS The study is a retrospective two-center cohort study. All COVID-19 patients admitted to critical care in the Region Östergötland County Council, Sweden, between March 2020 and September 2021 were included. Early (≤10 days from tracheal intubation) and late (>10 days) tracheostomy were compared. Through the Swedish intensive care registry, 249 mechanically ventilated COVID-19-positive patients ≥18 years old with respiratory failure were included. The pre-defined primary outcomes were the frequency and timing of tracheostomy. Secondary outcomes were days free of mechanical ventilation and intensive care, ICU discharge rate, ventilator weaning rate, and 60-day mortality. RESULTS Of 319 identified patients (70% men), 249 (78%) underwent endotracheal intubation. Of these, 145 (58%) underwent tracheostomy and 99 (68%) were performed early. Tracheostomy patients (vs. non-tracheostomy) had fewer IMV-free days and ICU-free days (27 [0-43] vs. 52 [43-55], p < .001, and 24 [0-40] vs. 49 [41-52], p < .001). Late (vs. early) tracheostomy patients had fewer IMV- and ICU-free days (16 [0-31] vs. 36 [0-47], p < .001 and 8 [0-28] vs. 32 [0-44], p < .001). Early tracheostomy (vs. late) was associated with a significantly higher ICU discharge rate (adjusted HR = 0.59, 95% CI [0.40-0.86], p = .006), but not with the weaning rate (adjusted HR = 0.64, 95% CI [0.12-3.32], p = .5) or 60-day mortality (adjusted HR = 1.27, 95% CI [0.61-2.67], p = .5). CONCLUSIONS Tracheostomy is common in critically ill COVID-19 patients. In patients predicted to need a tracheostomy at some point, early, rather than late, tracheostomy might be a means to reduce the time spent in ICU. However, we do not have sufficient evidence to suggest that early tracheostomy reduces mortality or weaning rates, compared with late tracheostomy.
Collapse
Affiliation(s)
- Louise Elander
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Centre for Clinical Research, Sörmland, Nyköping Hospital, Nyköping, Sweden
- Department of Anaesthesiology and Intensive Care in Norrköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anzal Abdirashid
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jonna Idh
- Department of Anaesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden
| | | | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
5
|
Burns KEA, Allan JE, Lee E, Santos-Taylor M, Kay P, Greco P, Every H, Mooney O, Tanios M, Tan E, Herry CL, Scales NB, Gouskos A, Tran A, Iyengar A, Maslove DM, Kutsogiannis J, Charbonney E, Mendelson A, Lellouche F, Lamontagne F, Scales D, Archambault P, Turgeon AF, Seely AJE, Group CCCT. Liberation from mechanical ventilation using Extubation Advisor Decision Support (LEADS): protocol for a multicentre pilot trial. BMJ Open 2025; 15:e093853. [PMID: 40107679 PMCID: PMC11927467 DOI: 10.1136/bmjopen-2024-093853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 02/10/2025] [Indexed: 03/22/2025] Open
Abstract
INTRODUCTION Timely successful liberation from invasive ventilation has the potential to minimise critically ill patients' exposure to invasive ventilation, save costs and improve outcomes; yet no trials have evaluated strategies to better inform extubation decision-making. The Liberation from mechanical ventilation using Extubation Advisor (EA) Decision Support (LEADS) Pilot Trial will assess the feasibility of a trial of a novel extubation decision support tool on feasibility metrics. The primary feasibility outcome will reflect our ability to recruit the desired population. Secondary feasibility outcomes will assess rates of (1) consent, (2) randomisation, (3) intervention adherence, (4) bidirectional crossovers and the (5) completeness of clinical outcomes collected. We will also evaluate physicians' perceptions of the usefulness of the EA tool and measure costs related to EA implementation. METHODS AND ANALYSIS We will include critically ill adults who are invasively ventilated for ≥48 hours and who are ready to undergo a spontaneous breathing trial (SBT) with a view to extubation. Patients in the intervention arm will undergo an EA assessment that measures respiratory rate variability to derive an estimate of extubation readiness. Treating clinicians (respiratory therapists, attending physicians and intensive care unit fellows) will receive an EA report for each SBT conducted. The EA report will assist, rather than direct, extubation decision-making. Patients in the control arm will receive standard care. SBTs will be directed by clinicians, using current best evidence, without EA assessments or reports. We aim to recruit 1 to 2 patients/month in approximately 10 centres, and to achieve >75% consent rate, >95% randomisation among consented patients, >80% of EA reports generated and delivered (intervention arm), <10% crossovers (both arms) and >90% of patients with complete clinical outcomes. We will also report physician point-of-care perceptions of the usefulness of the EA tool. ETHICS AND DISSEMINATION The LEADS Pilot Trial is approved by the Research Ethics Boards of all participating centres and Clinical Trials Ontario (4008). We will disseminate the LEADS trial findings through conference presentations and publication. TRIAL REGISTRATION NUMBER NCT05506904. PROTOCOL VERSION 24 April 2024.
Collapse
Affiliation(s)
- Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, North America, Canada
- Department of Critical Care Medicine, Unity Health Toronto, Toronto, North America, Canada
| | - Jill E Allan
- Ottawa Hospital Research Institute, Ottawa, North America, Canada
| | - Emma Lee
- Respiratory Therapy, Ottawa General Hospital, Ottawa, North America, Canada
| | | | - Phyllis Kay
- Patient and Family Advisory Committee, Unity Health Toronto, Toronto, North America, Canada
| | - Pamela Greco
- Respiratory Therapy, Unity Health Toronto, Toronto, North America, Canada
| | - Hilary Every
- Respiratory Therapy, Unity Health Toronto, Toronto, North America, Canada
| | - Owen Mooney
- Critical Care, University of Manitoba, Winnipeg, North America, Canada
| | - Maged Tanios
- Critical Care, Memorial Care Long Beach Medical Center, Long Beach, California, USA
| | - Edmund Tan
- Critical Care, Queen Elizabeth II Health Sciences Centre, Halifax, North America, Canada
| | | | - Nathan B Scales
- Ottawa Hospital Research Institute, Ottawa, North America, Canada
| | - Audrey Gouskos
- Patient and Family Advisory Committee, Unity Health Toronto, Toronto, North America, Canada
| | - Alexandre Tran
- Critical Care, University of Ottawa, Ottawa, North America, Canada
| | - Akshai Iyengar
- Medicine, University of Ottawa, Ottawa, North America, Canada
| | - David M Maslove
- Critical Care Medicine, Queen's University, Kingston, North America, Canada
| | - Jim Kutsogiannis
- Critical Care Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, North America, Canada
| | | | - Asher Mendelson
- Critical Care, University of Manitoba Faculty of Health Sciences, Winnipeg, North America, Canada
| | | | | | - Damon Scales
- Critical Care, Sunnybrook Health Sciences Centre, Toronto, North America, Canada
| | - Patrick Archambault
- Emergency Medicine, Université Laval, Québec, North America, Canada
- Université Laval, Hotel-Dieu de Levis, Levis, North America, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, North America, Canada
- Critical Care, CHA Hopital de l'Enfant-Jesus, Quebec, North America, Canada
| | - Andrew J E Seely
- Epidemiology, Ottawa Hospital Research Institute, Ottawa, North America, Canada
- Surgery, Ottawa Hospital, Ottawa, North America, Canada
| | | |
Collapse
|
6
|
Zoting A, Bhise S, Mategadikar P, Deshmukh P, Shrikhande S. Etiological Profile of Hospitalized Severe Acute Respiratory Infection (SARI) Patients During the COVID-19 Pandemic: A Cross-Sectional Study. Cureus 2025; 17:e80889. [PMID: 40255830 PMCID: PMC12009103 DOI: 10.7759/cureus.80889] [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] [Accepted: 03/20/2025] [Indexed: 04/22/2025] Open
Abstract
Background Lower respiratory infections remain one of the top global causes of death. The application of molecular diagnostic methods (e.g., reverse transcription-polymerase chain reaction {RT-PCR} panels) for the diagnosis of lower respiratory tract infections (LRTIs) improves the understanding of respiratory pathogen epidemiology of these diseases and helps in the early detection of causative agents and formulating infection control measures and management. Methods In this study, consecutive nasopharyngeal/oropharyngeal swab, sputum, tracheal aspirate, and bronchoalveolar lavage (BAL) samples collected from patients having respiratory symptoms were tested using RT-PCR. Results Out of 372 samples, respiratory pathogens were detected in 245 (65.86%) cases. The total number of viral isolates detected in this study was 235, including the viral co-infections and viral and bacterial mixed infections, out of which SARS-CoV-2 was most common (115, 48.94%), followed by influenza A(H1N1)pdm09 (82, 34.89%), rhinovirus (17, 7.23%), adenovirus (nine, 3.83%), influenza A (eight, 3.40%), and influenza B (four, 1.70%). Conclusion The rapid detection of respiratory pathogens through molecular methods can help with targeted antiviral treatment, limit the use of antibiotics, and help in knowing the burden of the disease.
Collapse
Affiliation(s)
- Anjali Zoting
- Microbiology, All India Institute of Medical Sciences, Raipur, Raipur, IND
| | - Swati Bhise
- Microbiology, Indira Gandhi Government Medical College, Nagpur, IND
| | | | | | | |
Collapse
|
7
|
Hodge AT, Tognolini AR, Martin EK, Eley VA. A cost analysis of the anaesthetic management of patients with confirmed or suspected coronavirus disease 2019 (COVID-19) in a tertiary referral hospital in Queensland, Australia. Anaesth Intensive Care 2025; 53:6-14. [PMID: 39757841 DOI: 10.1177/0310057x241272108] [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] [Indexed: 01/07/2025]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic in Australia resulted in significant additional infection control precautions for consumers and the health workforce. Prior to widespread vaccine availability, substantial changes were made to the operating theatre management of patients presenting for surgery with suspected or diagnosed COVID-19. This study aimed to calculate the actual costs of operating theatre care for patients with confirmed or suspected COVID-19. Data were prospectively collected for all patients presenting for surgery with confirmed or suspected COVID-19 at the Royal Brisbane and Women's Hospital. Information collected included patient characteristics, surgical and anaesthesia details, equipment, theatre utilisation, staffing and cleaning. The associated variable costs and usual costs of care were calculated according to the Australian National Efficient Price. We compared estimated usual costs with those estimated for patients with confirmed or suspected COVID-19. Twenty-four patients with suspected COVID-19 infection underwent surgery between May 2020 and February 2021. Cost analysis revealed a mean (standard deviation (SD), range) increase in costs of providing perioperative care for COVID-19 suspect patients of A$2252 (A$2570, A$315.85-10,398); that is, a mean of 207.5% more than usual care costs. This was primarily due to the increased number of staff and time required to complete these cases with appropriate infection control.
Collapse
Affiliation(s)
- Anthony T Hodge
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Angela R Tognolini
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elizabeth K Martin
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Wesley Research Institute, Brisbane, Australia
| | - Victoria A Eley
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
8
|
Jalilian H, Mohammadi P, Moradi A, Nikbina M, Sayfouri A, Birgani AN, Dehcheshmeh NF. Profession and role-based analysis of occupational exposure for COVID-19 among frontline healthcare workers in the pandemic: a risk assessment study. Sci Rep 2024; 14:31253. [PMID: 39732854 DOI: 10.1038/s41598-024-82611-4] [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: 09/09/2024] [Accepted: 12/06/2024] [Indexed: 12/30/2024] Open
Abstract
Healthcare workers are exposed to a high risk of COVID-19 infection due to close contact with infected patients in healthcare centers. This study aimed to investigate the level of exposure and risk of COVID-19 virus infection among healthcare workers working in primary healthcare centers in Khuzestan province, Iran. This cross-sectional study was conducted among 599 healthcare workers working in primary healthcare centers in the northern region of Khuzestan province, Iran, in 2022. Participants were recruited using a multistage and proportional stratified random sampling method. The WHO COVID-19 risk assessment tool was used to collect data. Data were analyzed using STATA V14.2. The prevalence of occupational and community exposure was 95.7% (93.7 to 97.1) and 89.6% (87.0 to 92.1), respectively. Healthcare workers with occupational exposure had a high risk of exposure (92.7%; 95% CI 90.1 to 94.6). There was no significant association between the type of profession, the role of primary health care workers, and the level of occupational exposure risk (P value > 0.05). The strength of the association was very weak (PR = 1.00; 95% CI 0.94 to 1.07). Also, a significant association was observed between the history of contact with biological materials and adherence to infection prevention and control measures with the level of occupational exposure to the virus (P value < 0.001). The strength of the association between contact with biological materials and exposure risk was weak (aPR = 1.20; 95% CI 1.12 to 1.29), but the strength of the association between adherence to infection prevention and control protocols and exposure risk was strong (aPR = 3.85; 95% CI 2.60 to 5.71). Furthermore, infection prevention and control was identified as a strong confounder in this study. The results showed that the prevalence of occupational exposure was high among healthcare workers, regardless of their profession and roles, with the majority of exposures being of high risk. Primary healthcare managers can play a major role in reducing exposure among high-risk healthcare workers by providing continuous personnel training, investing in the supply chain, prioritizing regular testing and vaccination of HCWs, and ensuring dedicated supervision while accurately monitoring compliance with health protocols during pandemics.
Collapse
Affiliation(s)
- Habib Jalilian
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parvin Mohammadi
- Department of Midwifery, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Moradi
- Department of Public Health, Shoushtar faculty of Medical Sciences, Shoushtar, Iran
| | - Maryam Nikbina
- Department of Midwifery, Shoushtar faculty of Medical Sciences, Shoushtar, Iran
| | - Amrollah Sayfouri
- Department of Health Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Anita Namdari Birgani
- Department of Masjedsoleyman Health Network, Deputy of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | |
Collapse
|
9
|
Saragosa M, Goraya F, Nowrouzi-Kia B, Gohar B. A qualitative study examining stressors among Respiratory Therapists in Ontario amidst the COVID-19 pandemic. PLoS One 2024; 19:e0312504. [PMID: 39666679 PMCID: PMC11637264 DOI: 10.1371/journal.pone.0312504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 10/07/2024] [Indexed: 12/14/2024] Open
Abstract
Health care systems were subjected to an unprecedented surge of critically ill patients with the coronavirus disease 2019 (COVID-19), which required management by Respiratory Therapists (RTs). Despite the high level of burnout reported in this health care professional group, we have limited knowledge about the lived experience of RTs during the pandemic. This study aims to examine the impact of COVID-19 on RTs in Ontario, Canada. We conducted a qualitative exploratory, descriptive study by conducting virtual semi-structured interviews and focus groups with RTs between March 2023 and June 2023. Two coders analyzed the data using thematic analysis. Twenty-seven RTs participated in the study, with the majority being female (n = 25), averaging 16.4 years of practice (range 4 to 36 years), primarily in acute care settings (n = 23). We identified four themes and lessons learned from the perspective of RTs: (1) Working in the shadow and suffering in silence reflecting varying perceptions of recognition; (2) Flying blind amidst the buzz reflecting the rapid pace of changing policies and practices as COVID-19 gained global attention; (3) Putting out fires in the face of overflowing hospitals reflecting increased workload and staffing issues; and (4) Managing tensions, both external and internal reflecting how RTs coped with distressing workplace situations and their mental well-being. Finally, lessons learned from the RTs include 1) Mobilizing early and consistently during an emergency, which addresses staff concerns; 2) Prioritizing and investing in the mental health and well-being of RTs; 3) Implementing strategies to retain experienced staff in healthcare; and 4) Involving RTs in leadership discussions. The COVID-19 stressors of RTs have illuminated the detrimental impact of the pandemic on this understudied health care profession. With this knowledge, targeted interventions can be developed to address RT recognition and staff retention and provide mental health support.
Collapse
Affiliation(s)
- Marianne Saragosa
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Farwa Goraya
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science & Occupational Therapy, University of Toronto Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Research in Occupational Safety & Health, Sudbury, ON, Canada
| | - Basem Gohar
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
- Centre for Research in Occupational Safety & Health, Sudbury, ON, Canada
| |
Collapse
|
10
|
Allison JR, Tiede S, Holliday R, Durham J, Jakubovics NS. Bioaerosols and Airborne Transmission in the Dental Clinic. Int Dent J 2024; 74 Suppl 2:S418-S428. [PMID: 39515929 PMCID: PMC11583874 DOI: 10.1016/j.identj.2024.09.026] [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: 07/05/2024] [Revised: 09/13/2024] [Accepted: 09/20/2024] [Indexed: 11/16/2024] Open
Abstract
The importance of aerosols (particles suspended in air) produced during dental procedures became more apparent than ever during the COVID-19 pandemic. Concerns over transmission of infection in these aerosols led to unprecedented disruption to dental services across the world, adversely impacting patients' oral health. This article discusses the evidence related to airborne transmission of infectious diseases and the relevance to dentistry. The production of bioaerosols (aerosols carrying biological material) during dental procedures is explored, as well as how the potential risks posed by these bioaerosols can be controlled. A better understanding of dental bioaerosols is needed to prevent similar disruption to dental services in future outbreaks, and to reduce the risk of infection of dental professionals when treating patients with active infections who require urgent or emergency dental care.
Collapse
Affiliation(s)
- James R Allison
- Faculty of Medical Sciences, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | | | - Richard Holliday
- Faculty of Medical Sciences, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Justin Durham
- Faculty of Medical Sciences, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicholas S Jakubovics
- Faculty of Medical Sciences, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
11
|
Guedes F, Ferreira AJ, Dionísio J, Rodrigues LV, Bugalho A. Pre- and post-COVID practice of interventional pulmonology in adults in Portugal. Pulmonology 2024; 30:537-545. [PMID: 35339419 DOI: 10.1016/j.pulmoe.2022.02.009] [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: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES There is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak. MATERIALS AND METHODS An online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021. RESULTS 37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak. CONCLUSIONS IP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.
Collapse
Affiliation(s)
- F Guedes
- Pulmonology Department, Centre Hospitalier de Luxembourg, Luxembourg; Centro de Estudos de Ciência Animal (CECA), Instituto de Ciências, Tecnologias e Agroambiente (ICETA) da Universidade do Porto, Porto, Portugal.
| | - A J Ferreira
- Pulmonology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - J Dionísio
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - L V Rodrigues
- Pulmonology Department, Instituto Português de Oncologia Francisco Gentil, Coimbra, Portugal
| | - A Bugalho
- Pulmonology Department, CUF Tejo Hospital and CUF Descobertas Hospital, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Lisbon, Portugal
| |
Collapse
|
12
|
Wang C, Tay J, Wu C, Wu M, Su P, Fang Y, Huang C, Cheng M, Lu T, Tsai C, Huang C, Chen W. External Validation and Comparison of Statistical and Machine Learning-Based Models in Predicting Outcomes Following Out-of-Hospital Cardiac Arrest: A Multicenter Retrospective Analysis. J Am Heart Assoc 2024; 13:e037088. [PMID: 39392158 PMCID: PMC11935587 DOI: 10.1161/jaha.124.037088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/13/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND The aim of this study was to validate and compare the performance of statistical (Utstein-Based Return of Spontaneous Circulation and Shockable Rhythm-Witness-Age-pH) and machine learning-based (Prehospital Return of Spontaneous Circulation and Swedish Cardiac Arrest Risk Score) models in predicting the outcomes following out-of-hospital cardiac arrest and to assess the impact of the COVID-19 pandemic on the models' performance. METHODS AND RESULTS This retrospective analysis included adult patients with out-of-hospital cardiac arrest treated at 3 academic hospitals between 2015 and 2023. The primary outcome was neurological outcomes at hospital discharge. Patients were divided into pre- (2015-2019) and post-2020 (2020-2023) subgroups to examine the effect of the COVID-19 pandemic on out-of-hospital cardiac arrest outcome prediction. The models' performance was evaluated using the area under the receiver operating characteristic curve and compared by the DeLong test. The analysis included 2161 patients, 1241 (57.4%) of whom were resuscitated after 2020. The cohort had a median age of 69.2 years, and 1399 patients (64.7%) were men. Overall, 69 patients (3.2%) had neurologically intact survival. The area under the receiver operating characteristic curves for predicting neurological outcomes were 0.85 (95% CI, 0.83-0.87) for the Utstein-Based Return of Spontaneous Circulation score, 0.82 (95% CI, 0.81-0.84) for the Shockable Rhythm-Witness-Age-pH score, 0.79 (95% CI, 0.78-0.81) for the Prehospital Return of Spontaneous Circulation score, and 0.79 (95% CI, 0.77-0.81) for the Swedish Cardiac Arrest Risk Score model. The Utstein-Based Return of Spontaneous Circulation score significantly outperformed both the Prehospital Return of Spontaneous Circulation score (P<0.001) and the Swedish Cardiac Arrest Risk Score model (P=0.007). Subgroup analysis indicated no significant difference in predictive performance for patients resuscitated before versus after 2020. CONCLUSIONS In this external validation, both statistical and machine learning-based models demonstrated excellent and fair performance, respectively, in predicting neurological outcomes despite different model architectures. The predictive performance of all evaluated clinical scoring systems was not significantly influenced by the COVID-19 pandemic.
Collapse
Affiliation(s)
- Chih‐Hung Wang
- Department of Emergency Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Joyce Tay
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Cheng‐Yi Wu
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Meng‐Che Wu
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Pei‐I Su
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Yao‐De Fang
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chun‐Yen Huang
- Department of Emergency MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Ming‐Tai Cheng
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University Hospital Yunlin branchYunlin CountyTaiwan
| | - Tsung‐Chien Lu
- Department of Emergency Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chu‐Lin Tsai
- Department of Emergency Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Chien‐Hua Huang
- Department of Emergency Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Wen‐Jone Chen
- Department of Emergency Medicine, College of MedicineNational Taiwan UniversityTaipeiTaiwan
- Department of Emergency MedicineNational Taiwan University HospitalTaipeiTaiwan
- Department of Internal MedicineMin‐Sheng General HospitalTaoyuanTaiwan
| |
Collapse
|
13
|
Lin FC, Chen YH, Kuo YW, Ku SC, Jerng JS. Aerosol particle dispersion in spontaneous breathing training of oxygen delivery tracheostomized patients on prolonged mechanical ventilation. J Formos Med Assoc 2024; 123:1104-1109. [PMID: 38336509 DOI: 10.1016/j.jfma.2024.01.028] [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: 09/16/2023] [Revised: 12/29/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Tracheostomized patients undergoing liberation from mechanical ventilation (MV) are exposed to the ambient environment through humidified air, potentially heightening aerosol particle dispersion. This study was designed to evaluate the patterns of aerosol dispersion during spontaneous breathing trials in such patients weaning from prolonged MV. METHODS Particle Number Concentrations (PNC) at varying distances from tracheostomized patients in a specialized weaning unit were quantified using low-cost particle sensors, calibrated against a Condensation Particle Counter. Different oxygen delivery methods, including T-piece and collar mask both with the humidifier or with a small volume nebulizer (SVN), and simple collar mask, were employed. The PNC at various distances and across different oxygen devices were compared using the Kruskal-Wallis test. RESULTS Of nine patients receiving prolonged MV, five underwent major surgery, and eight were successfully weaned from ventilation. PNCs at distances ranging from 30 cm to 300 cm showed no significant disparity (H(4) = 8.993, p = 0.061). However, significant differences in PNC were noted among oxygen delivery methods, with Bonferroni-adjusted pairwise comparisons highlighting differences between T-piece or collar mask with SVN and other devices. CONCLUSION Aerosol dispersion within 300 cm of the patient was not significantly different, while the nebulization significantly enhances ambient aerosol dispersion in tracheostomized patients on prolonged MV.
Collapse
Affiliation(s)
- Feng-Ching Lin
- Division of Respiratory Therapy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan; School of Respiratory Therapy, Taipei Medical University, Taipei, Taiwan
| | - Yung-Hsuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Wen Kuo
- Division of Respiratory Therapy, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
14
|
Avakame EF, Boyer DL. Accounting for "Hidden Costs": Provider Workload as a Balancing Metric in Evaluating Procedural Innovations. Pediatr Crit Care Med 2024; 25:970-972. [PMID: 39360917 DOI: 10.1097/pcc.0000000000003561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Affiliation(s)
- Elorm F Avakame
- Division of Pediatric Critical Care and Hospital Medicine, Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Donald L Boyer
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
15
|
Orrock JL, Ward PA, McNarry AF. Routine Use of Videolaryngoscopy in Airway Management. Int Anesthesiol Clin 2024; 62:48-58. [PMID: 39233571 DOI: 10.1097/aia.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Tracheal intubation is a fundamental facet of airway management, for which the importance of achieving success at the first attempt is well recognized. Failure to do so can lead to significant morbidity and mortality if there is inadequate patient oxygenation by alternate means. The evidence supporting the benefits of a videolaryngoscope in attaining this objective is now overwhelming (in adults). This has led to its increasing recognition in international airway management guidelines and its promotion from an occasional airway rescue tool to the first-choice device during routine airway management. However, usage in clinical practice does not currently reflect the increased worldwide availability that followed the upsurge in videolaryngoscope purchasing during the coronavirus disease 2019 pandemic. There are a number of obstacles to widespread adoption, including lack of adequate training, fears over de-skilling at direct laryngoscopy, equipment and cleaning costs, and concerns over the environmental impact, among others. It is now clear that in order for patients to benefit maximally from the technology and for airway managers to fully appreciate its role in everyday practice, proper training and education are necessary. Recent research evidence has addressed some existing barriers to default usage, and the emergence of techniques such as awake videolaryngoscopy and video-assisted flexible (bronchoscopic) intubation has also increased the scope of clinical application. Future studies will likely further confirm the superiority of videolaryngoscopy over direct laryngoscopy, therefore, it is incumbent upon all airway managers (and their teams) to gain expertise in videolaryngoscopy and to use it routinely in their everyday practice..
Collapse
Affiliation(s)
- Jane Louise Orrock
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK
| | | | - Alistair Ferris McNarry
- Department of Anaesthesia, St John's Hospital, NHS Lothian, Livingston, UK
- Department of Anaesthesia, Western General Hospital, NHS Lothian, Edinburgh, UK
| |
Collapse
|
16
|
Mei L, Hou Y, Zhou J, Chang Y, Liu Y, Wang D, Zhang Y, Ning S, Li X. AVM: A Manually Curated Database of Aerosol-transmitted Virus Mutations, Human Diseases, and Drugs. GENOMICS, PROTEOMICS & BIOINFORMATICS 2024; 22:qzae041. [PMID: 39353863 PMCID: PMC12016557 DOI: 10.1093/gpbjnl/qzae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/23/2024] [Accepted: 05/30/2024] [Indexed: 10/04/2024]
Abstract
Aerosol-transmitted viruses possess strong infectivity and can spread over long distances, earning the difficult-to-control title. They cause various human diseases and pose serious threats to human health. Mutations can increase the transmissibility and virulence of the strains, reducing the protection provided by vaccines and weakening the efficacy of antiviral drugs. In this study, we established a manually curated database (termed AVM) to store information on aerosol-transmitted viral mutations (VMs). The current version of the AVM contains 42,041 VMs (including 2613 immune escape mutations), 45 clinical information datasets, and 407 drugs/antibodies/vaccines. Additionally, we recorded 88 human diseases associated with viruses and found that the same virus can target multiple organs in the body, leading to diverse diseases. Furthermore, the AVM database offers a straightforward user interface for browsing, retrieving, and downloading information. This database is a comprehensive resource that can provide timely and valuable information on the transmission, treatment, and diseases caused by aerosol-transmitted viruses (http://www.bio-bigdata.center/AVM).
Collapse
Affiliation(s)
- Lan Mei
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Yaopan Hou
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Jiajun Zhou
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Yetong Chang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Yuwei Liu
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Di Wang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Yunpeng Zhang
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Xia Li
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| |
Collapse
|
17
|
van Doremalen N, Bushmaker T, Fischer RJ, Okumura A, Figueroa Acosta DM, McMinn RJ, Letko M, Scott D, Saturday G, Munster VJ. Transmission dynamics of MERS-CoV in a transgenic human DPP4 mouse model. NPJ VIRUSES 2024; 2:36. [PMID: 40295821 PMCID: PMC11721671 DOI: 10.1038/s44298-024-00048-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/20/2024] [Indexed: 04/30/2025]
Abstract
Since 2002, three novel coronavirus outbreaks have occurred: severe acute respiratory syndrome coronavirus (SARS-CoV-1), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2. A better understanding of the transmission potential of coronaviruses will result in adequate infection control precautions and an early halt of transmission within the human population. Experiments on the stability of coronaviruses in the environment, as well as transmission models, are thus pertinent.Here, we show that transgenic mice expressing human DPP4 can be infected with MERS-CoV via the aerosol route. Exposure to 5 × 106 TCID50 and 5 × 104 TCID50 MERS-CoV per cage via fomites resulted in transmission in 15 out of 20 and 11 out of 18 animals, respectively. Exposure of sentinel mice to donor mice one day post inoculation with 105 TCID50 MERS-CoV resulted in transmission in 1 out of 38 mice via direct contact and 4 out of 54 mice via airborne contact. Exposure to donor mice inoculated with 104 TCID50 MERS-CoV resulted in transmission in 0 out of 20 pairs via direct contact and 0 out of 5 pairs via the airborne route. Our model shows limited transmission of MERS-CoV via the fomite, direct contact, and airborne routes. The hDPP4 mouse model will allow assessment of the ongoing evolution of MERS-CoV in the context of acquiring enhanced human-to-human transmission kinetics and will inform the development of other transmission models.
Collapse
Affiliation(s)
- Neeltje van Doremalen
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Trenton Bushmaker
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Robert J Fischer
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Atsushi Okumura
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Dania M Figueroa Acosta
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebekah J McMinn
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Michael Letko
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Dana Scott
- Division of Intramural Research, Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Greg Saturday
- Division of Intramural Research, Rocky Mountain Veterinary Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA
| | - Vincent J Munster
- Division of Intramural Research, Laboratory of Virology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT, USA.
| |
Collapse
|
18
|
Chacko B, Chaudhry D, Peter JV, Khilnani GC, Saxena P, Sehgal IS, Ahuja K, Rodrigues C, Modi M, Jaiswal A, Jasiel GJ, Sahasrabudhe S, Bose P, Ahuja A, Suprapaneni V, Prajapat B, Manesh A, Chawla R, Guleria R. ISCCM Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024; 28:S67-S91. [PMID: 39234233 PMCID: PMC11369919 DOI: 10.5005/jp-journals-10071-24783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 07/24/2024] [Indexed: 09/06/2024] Open
Abstract
Tuberculosis (TB) is an important cause of morbidity and mortality globally. About 3-4% of hospitalized TB patients require admission to the intensive care unit (ICU); the mortality in these patients is around 50-60%. There is limited literature on the evaluation and management of patients with TB who required ICU admission. The Indian Society of Critical Care Medicine (ISCCM) constituted a working group to develop a position paper that provides recommendations on the various aspects of TB in the ICU setting based on available evidence. Seven domains were identified including the categorization of TB in the critically ill, diagnostic workup, drug therapy, TB in the immunocompromised host, organ support, infection control, and post-TB sequelae. Forty-one questions pertaining to these domains were identified and evidence-based position statements were generated, where available, keeping in focus the critical care aspects. Where evidence was not available, the recommendations were based on consensus. This position paper guides the approach to and management of critically ill patients with TB. How to cite this article Chacko B, Chaudhry D, Peter JV, Khilnani G, Saxena P, Sehgal IS, et al. isccm Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024;28(S2):S67-S91.
Collapse
Affiliation(s)
- Binila Chacko
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pt BDS Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - John V Peter
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gopi C Khilnani
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Prashant Saxena
- Department of Pulmonary, Critical Care and Sleep Medicine, Fortis Hospital, Vasant Kung, New Delhi, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Kunal Ahuja
- Department of Pulmonary, Critical Care and Sleep Medicine, PSRI Hospital, New Delhi, India
| | - Camilla Rodrigues
- Department of Lab Medicine, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Manish Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Anand Jaiswal
- Deparment of Respiratory Diseases, Medanta Medicity, Gurugram, Haryana, India
| | - G Joel Jasiel
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shrikant Sahasrabudhe
- Department of Critical Care Medicine and Pulmonology, KIMS Manavata Hospital, Nashik, Maharashtra, India
| | - Prithviraj Bose
- Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aman Ahuja
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Vineela Suprapaneni
- Department of Pulmonary and Critical Care Medicine, PGIMS, Rohtak, Haryana, India
| | - Brijesh Prajapat
- Department of Pulmonary and Critical Care Medicine, Yashoda Group of Hospitals, Ghaziabad, Uttar Pradesh, India
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Chawla
- Department of Respiratory Medicine, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- Institute of Internal Medicine and Respiratory and Sleep Medicine, Medanta Medical School, Gurugram, Haryana, India
| |
Collapse
|
19
|
Liu J, Ma L, Hu C, Kang J, Zhang B, Li R, Liao H. A robot-assisted tracheal intubation system based on a soft actuator? Int J Comput Assist Radiol Surg 2024; 19:1495-1504. [PMID: 38862746 DOI: 10.1007/s11548-024-03209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Tracheal intubation is the gold standard of airway protection and constitutes a pivotal life-saving technique frequently employed in emergency medical interventions. Hence, in this paper, a system is designed to execute tracheal intubation tasks automatically, offering a safer and more efficient solution, thereby alleviating the burden on physicians. METHODS The system comprises a tracheal tube with a bendable front end, a drive system, and a tip endoscope. The soft actuator provides two degrees of freedom for precise orientation. It is fabricated with varying-hardness silicone and reinforced with fibers and spiral steel wire for flexibility and safety. The hydraulic actuation system and tube feeding mechanism enable controlled bending and delivery. Object detection of key anatomical features guides the robotic arm and soft actuator. The control strategy involves visual servo control for coordinated robotic arm and soft actuator movements, ensuring accurate and safe tracheal intubation. RESULTS The kinematics of the soft actuator were established using a constant curvature model, allowing simulation of its workspace. Through experiments, the actuator is capable of 90° bending as well as 20° deflection on the left and right sides. The maximum insertion force of the tube is 2 N. Autonomous tracheal intubation experiments on a training manikin were successful in all 10 trials, with an average insertion time of 45.6 s. CONCLUSION Experimental validation on the manikin demonstrated that the robot tracheal intubation system based on a soft actuator was able to perform safe, stable, and automated tracheal intubation. In summary, this paper proposed a safe and automated robot-assisted tracheal intubation system based on a soft actuator, showing considerable potential for clinical applications.
Collapse
Affiliation(s)
- Jiayuan Liu
- School of Biomedical Engineering, Tsinghua University, Beijing, 100084, China
| | - Longfei Ma
- School of Biomedical Engineering, Tsinghua University, Beijing, 100084, China
| | - Chengquan Hu
- School of Biomedical Engineering, Tsinghua University, Beijing, 100084, China
| | - Jingyi Kang
- School of Biomedical Engineering, Tsinghua University, Beijing, 100084, China
| | - Boyu Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
| | - Ruiyang Li
- School of Biomedical Engineering, Tsinghua University, Beijing, 100084, China
| | - Hongen Liao
- School of Biomedical Engineering, Tsinghua University, Beijing, 100084, China.
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China.
| |
Collapse
|
20
|
Clemency BM, Clay C, Varughese R, Kennedy C, Yates W, Lat A, Ling Ching A, Clark D, Lewin D, Chen X, Castro M. Impact of nebulization versus metered-dose inhaler utilization on viral particle dispersion in patients with COVID-19. J Infect Prev 2024:17571774241266420. [PMID: 39544634 PMCID: PMC11559436 DOI: 10.1177/17571774241266420] [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: 11/14/2023] [Accepted: 05/30/2024] [Indexed: 11/17/2024] Open
Abstract
Background Conflicting guidance exists regarding the characterization of nebulization as an aerosol-generating procedure and subsequent risk of transmission of SARS-CoV-2 to healthcare workers. Aim/Objective This study sought to address whether SARS-CoV-2 viral load distribution was impacted by bronchodilator delivery via nebulizer versus metered-dose inhaler (MDI). Methods Adults infected with COVID-19 were enrolled and received a single dose of albuterol sulfate nebulized solution (2.5 mg/3 mL via breath-actuated nebulizer with filtered mouthpiece) or albuterol sulfate hydrofluoroalkane inhalation aerosol (90 µg/actuation; two puffs via MDI with spacer) in a randomized crossover sequence. Air and surfaces were sampled at predefined locations within patients' hospital rooms to assess SARS-CoV-2 dispersion over three periods (baseline, MDI, and nebulizer). Findings/Results Eleven patients received crossover therapy. Six patients had detectable SARS-CoV-2 RNA during one treatment period (n = 3 each for MDI and nebulizer) and one during both treatment periods. No viral RNA was found in the rooms of four (36.4%) patients. Overall, few environmental samples (17/397; 4.3%) contained detectable viral RNA, with no meaningful differences in positivity rate across periods; RNA genome copy numbers were low in positive samples. No correlation between dispersion and patient clinical status or environmental parameters was observed. Discussion In this first prospective trial evaluating viral load distribution following use of nebulizer versus MDI in hospitalized patients with COVID-19, low environmental contamination was found regardless of administration method. Findings support the use of either device when needed to treat patients with COVID-19.
Collapse
Affiliation(s)
- Brian M Clemency
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Candice Clay
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Renoj Varughese
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Carli Kennedy
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Wayne Yates
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Asma Lat
- Dermavant Sciences, Inc., Morrisville, NC, USA
| | | | - Doug Clark
- Aligos Therapeutics, Inc., South San Francisco, CA, USA
| | - David Lewin
- Statistically Speaking Consulting, LLC, Venice, FL, USA
| | - Xianyi Chen
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Mario Castro
- University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
21
|
Kaur M, Kumar A, Kaur S, Nagar PK, Nagi M, Thakur V, Khan R. Adverse Effects of Personal Protective Equipment and Their Self-Practiced Preventive Strategies among the Covid-19 Frontline Health Care Workers. Hosp Top 2024; 102:152-163. [PMID: 35983853 DOI: 10.1080/00185868.2022.2112523] [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] [Indexed: 10/15/2022]
Abstract
BACKGROUND Owing to the highly contagious nature of SARS-CoV-2, the use of personal protective equipment (PPE) among the healthcare workers (HCWs) is mandatory. However, PPE associated adverse effects are also there. OBJECTIVE To study the adverse effects associated with PPE and their preventive measures amongst the HCWs. MATERIAL AND METHODS A descriptive study was conducted among 200 HCWs working in a Covid center of a tertiary care center. The participants were sent the questionnaires online. Some of them not having smart phones were interviewed telephonically. Their information profile, the various adverse effects associated with PPE, and the preventive measures being practiced by them were noted. Data was analyzed using descriptive and inferential statistics. RESULTS Total 97% HCWs reported adverse effects with hazmat suit; 96% with N 95 mask; 92% with goggle and 78% with gloves. The adverse effects associated with the prolonged use of the mask were erythema; erosions and scar at the nasal bridge; ear pain; difficulty in breathing; and headache. Sixty-seven percent of the participants had sweating with the use of gloves, which led to cutaneous exfoliation such as dry hands (55%) and skin itching (43%). Moisturizers and natural oils were used to prevent the dryness of hands. For the pressure related injury over the nasal bridge due to N95 mask, participants used to apply Band-Aid (adhesive bandage) and cotton dressing. CONCLUSION Adverse skin reactions related to PPE are common among HCWs. Comprehensive assessment of the skin condition and awareness on adverse skin reactions should be advocated.
Collapse
Affiliation(s)
| | - Ashok Kumar
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | | | - Manisha Nagi
- National Institute of Nursing Education, PGIMER, Chandigarh, India
| | - Vishal Thakur
- Department of Dermatology, Venereology & Leprology, Himalayan Institute of Medical Sciences, Uttarakhand, India
| | - Reshma Khan
- Nursing Department, PGIMER, Chandigarh, India
| |
Collapse
|
22
|
Klompas M. Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic. Respir Care 2024; 69:854-868. [PMID: 38806219 PMCID: PMC11285502 DOI: 10.4187/respcare.11961] [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] [Indexed: 05/30/2024]
Abstract
The COVID-19 pandemic has had an unprecedented impact on population health and hospital operations. Over 7 million patients have been hospitalized for COVID-19 thus far in the United States alone. Mortality rates for hospitalized patients during the first wave of the pandemic were > 30%, but as we enter the fifth year of the pandemic hospitalizations have fallen and mortality rates for hospitalized patients with COVID-19 have plummeted to 5% or less. These gains reflect lessons learned about how to optimize respiratory support for different kinds of patients, targeted use of therapeutics for patients with different manifestations of COVID-19 including immunosuppressants and antivirals as appropriate, and high levels of population immunity acquired through vaccines and natural infections. At the same time, the pandemic has helped highlight some longstanding sources of harm for hospitalized patients including hospital-acquired pneumonia, ventilator-associated events (VAEs), and hospital-acquired respiratory viral infections. We are, thankfully, on the leeside of the pandemic at present; but the large increases in ventilator-associated pneumonia (VAP), VAEs, bacterial superinfections, and nosocomial respiratory viral infections associated with the pandemic beg the question of how best to prevent these complications moving forward. This paper reviews the burden of hospitalization for COVID-19, the intersection between COVID-19 and both VAP and VAEs, the frequency and impact of hospital-acquired respiratory viral infections, new recommendations on how best to prevent VAP and VAEs, and current insights into effective strategies to prevent nosocomial spread of respiratory viruses.
Collapse
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
23
|
Hayden MK, Hanson KE, Englund JA, Lee MJ, Loeb M, Lee F, Morgan DJ, Patel R, El Mikati IK, Iqneibi S, Alabed F, Amarin JZ, Mansour R, Patel P, Falck-Ytter Y, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing (December 2023). Clin Infect Dis 2024; 78:e385-e415. [PMID: 38112284 PMCID: PMC12098001 DOI: 10.1093/cid/ciad646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Indexed: 12/21/2023] Open
Abstract
Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.
Collapse
Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robin Patel
- Division of Clinical Microbiology and Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shahad Iqneibi
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Farouk Alabed
- School of Medicine, The University of Kansas, Kansas City, Kansas, USA
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Adarsh Bhimraj
- Houston Methodist Hospital, Center of Excellence for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
24
|
Muner K, Kilgour J, Ometto T, Brandão APD, dos Santos AP, Guimarães AMS. Cross-sectional study of personal protective equipment use, training and biosafety preparedness among healthcare workers during the first months of the SARS-CoV-2 pandemic in Brazil. BMJ PUBLIC HEALTH 2024; 2:e000654. [PMID: 40018173 PMCID: PMC11812835 DOI: 10.1136/bmjph-2023-000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/26/2024] [Indexed: 03/01/2025]
Abstract
Objectives Brazil has high rates of COVID-19 and tuberculosis among healthcare workers (HCWs). Personal protective equipment (PPE) is essential for their protection. We aimed to evaluate PPE use, training, and preparedness among HCWs in the early months of the SARS-CoV-2 pandemic in Brazil. Methods A cross-sectional study was performed using questionnaires available to HCWs through a website created to provide PPE guidelines. χ2 test and robust Poisson regression identified factors associated with HCWs treating COVID-19 patients (TCOVID-19), lack of training on PPE use and N95 respirator reuse. The speech content of open-ended questions was analysed. Results We analysed 1410 questionnaires collected from April to July 2020 representing 526 Brazilian cities. HCWs-TCOVID-19 had fewer years of work experience, were more likely to reuse PPE, and reported higher stress levels and lower biosafety at the workplace than HCWs not TCOVID-19 patients. Fearful concerns, limited PPE access and pandemic unpreparedness were common among HCWs. Lack of PPE training was associated with the profession and no N95 respirator fit tests. N95 reuse during the pandemic, common to 78% of the HCWs, was associated with the reuse of PPE during the pandemic and reuse of N95 before the pandemic. Conclusions We report the unpreparedness of HCWs and institutions to handle the pandemic, with low rates of training and N95 respirator fit testing and high PPE reuse. N95 reuse was a pre-established practice. This chronic unpreparedness to deal with airborne pathogens may have contributed to one of the highest global rates of tuberculosis and COVID-19 among HCWs.
Collapse
Affiliation(s)
- Kerstin Muner
- Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Comparative Pathobiology, Purdue University, West Lafayette, Indiana, USA
| | - Julia Kilgour
- Animal Sciences, Purdue University, West Lafayette, Indiana, USA
| | - Tatiana Ometto
- Microbiology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana Pérola Drulla Brandão
- General Coordination of Surveillance of Vaccine-Preventable Diseases, Secretariat of Health and Environmental Surveillance, Brazilian Ministry of Health, Brasília, Brazil
| | | | | |
Collapse
|
25
|
Tochigi K, Sakamoto H, Omura K, Kessoku H, Takeda T, Oguro R, Kojima H, Tanaka Y. Safety of cricotracheostomy with skin and tracheal membrane flaps for severe COVID-19 patients. Auris Nasus Larynx 2024; 51:583-587. [PMID: 38552421 DOI: 10.1016/j.anl.2024.03.003] [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: 06/12/2023] [Revised: 02/04/2024] [Accepted: 03/13/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Airway surgery is performed for COVID-19 patients who require long-term tracheal intubation and mechanical ventilation. Tracheostomy sometimes causes postoperative complications represented by bleeding at a relatively high rate in COVID-19 patients. As an alternative surgical procedure to tracheostomy, cricotracheostomy may reduce these complications, but few studies have examined its safety. METHODS Data were retrospectively collected for sixteen COVID-19 patients (11 underwent tracheostomy, 5 underwent modified cricotracheostomy). In addition to patients' backgrounds and blood test data, the frequency of complications and additional care required for postoperative complications were collected. Statistical analysis was conducted by the univariate analysis of Fischer analysis and Mann-Whitney U test. RESULTS Five cases experienced postoperative bleeding, four cases experienced peristomal infection, and one case experienced subcutaneous emphysema in the tracheostomy patients. These complications were not observed in the cricotracheostomy patients. The number of additional cares for postoperative complications was significantly lower in cricotracheostomy than in tracheostomy patients (p < 0.05). CONCLUSIONS Modified cricotracheostomy could be a safe procedure in airway surgery for patients with COVID-19 from the point of fewer postoperative complications and additional care. It might be necessary to select the cricotracheostomy depending on patients' background to reduce postoperative complications.
Collapse
Affiliation(s)
- Kosuke Tochigi
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hikaru Sakamoto
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Kazuhiro Omura
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan; Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Hisashi Kessoku
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Teppei Takeda
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryoji Oguro
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromi Kojima
- Department of Otorhinolaryngology/Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology/Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| |
Collapse
|
26
|
Kaneko T, Kato T, Shiko Y, Kawasaki Y, Koyama K. Assessment of pre-extubating recurrent laryngeal nerve palsy using ultrasound in postoperative patients with esophageal cancer: a prospective observational study. J Anesth 2024; 38:347-353. [PMID: 38430260 PMCID: PMC11096227 DOI: 10.1007/s00540-024-03315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 02/01/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Ultrasound performed after extubation has been suggested to be useful for the diagnosis of recurrent laryngeal nerve (RLN) paralysis. However, the use of ultrasound for this purpose before extubation has not been examined. The aim of this study was to examine the versatility (interrater reliability) and usefulness of ultrasound for evaluating the movement of vocal cords before extubation. METHODS The subjects were 30 patients who underwent radical surgery for esophageal cancer from August 2020 to December 2021. An experienced examiner performed an ultrasound examination before and after elective extubation on the day after surgery to evaluate RLN paralysis and record videos. Bronchoscopy was then performed to make a definite diagnosis. Three anesthetists blinded to the diagnosis also evaluated the cases using the videos, and the versatility of the examination was determined using a kappa test. RESULTS The diagnostic accuracies of the examiner and three anesthetists were 76.7%, 50.0%, 53.3%, and 46.7%, respectively, and the kappa coefficients for the examiner with the anesthetists were 0.310, 0.502, and 0.169, respectively. The sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of RLN paralysis by the examiner using ultrasound before extubation were 0.57, 0.95, 0.80, and 0.87, respectively. CONCLUSION These results indicate a lack of versatility of the ultrasound examination based on the low kappa coefficients. However, with an experienced examiner, ultrasound can serve as a non-invasive examination that can be performed before extubation with high accuracy and specificity for diagnosis of postoperative RLN paralysis.
Collapse
Affiliation(s)
- Tomomi Kaneko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-city, Saitama, 350-8550, Japan.
| | - Takao Kato
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-city, Saitama, 350-8550, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Kaoru Koyama
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-city, Saitama, 350-8550, Japan
| |
Collapse
|
27
|
Wahid NW, Deutsch P, Amlani A, Gupta KK, Griffiths H, Ahmad I. Bedside open tracheostomy in COVID-19 patients - a safe and swift approach. Med Oral Patol Oral Cir Bucal 2024; 29:e356-e361. [PMID: 37992143 PMCID: PMC11175577 DOI: 10.4317/medoral.26326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals. MATERIAL AND METHODS As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open-bedside, open-theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations. RESULTS Thirty patients underwent tracheostomy during the study period (14 bedside-open, 5 open-theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside-open tracheostomy was 14.5 days. The average time for open-bedside tracheostomy was 9 minutes compared to 31 minutes for open-theatre. There were no significant tracheostomy related complications with bedside-open tracheostomy. No healthcare professional involved reported acute COVID-19 infection. CONCLUSIONS We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.
Collapse
Affiliation(s)
- N-W Wahid
- Birmingham Heartlands Hospital B9 5SS, Bordesley Green East Birmingham, United Kingdom
| | | | | | | | | | | |
Collapse
|
28
|
Gojayev EK, Büyükatalay ZÇ, Akyüz T, Rehan M, Dursun G. The Effect of Masks and Respirators on Acoustic Voice Analysis During the COVID-19 Pandemic. J Voice 2024; 38:798.e1-798.e6. [PMID: 34961655 PMCID: PMC8627850 DOI: 10.1016/j.jvoice.2021.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/31/2021] [Accepted: 11/23/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES World Health Organization declared the coronavirus disease (COVID-19) as a global pandemic on March 11, 2020. The aim of this study was to determine the effectiveness and reliability of voice analysis performed with surgical masks and respirators during the pandemic and to discuss its routine applicability. METHODS This prospective study included 204 patients who applied to our clinic between the ages of 18 and 55, whose preoperative SARS-Cov-2 PCR tests were negative. Voice analyses were performed on each patient without a mask, with a surgical mask and with a valved face-filtering piece-3 (FFP3) respirator respectively. The F0, shimmer, jitter, s/z ratio, maximum phonation time and harmonic/noise ratio (HNR) values obtained from the voice analyses were compared with each other. RESULTS No significant difference was found in terms of F0, Jitter, Shimmer, HNR, s/z and maximum phonation time values in the voice analyses performed without a mask and with a surgical mask. With an FFP3, a significant difference was found in only the Shimmer and HNR values compared to the other analysis values. When we look at the data with sex distinction, in the group of female and male patients, when the data of voice analysis obtained in three situations were compared, different results were obtained from the female and male group. CONCLUSION In conclusion, it should be decided by the physician to perform the voice analysis with a surgical mask or with an FFP3, considering the clinically desired parameters.
Collapse
Affiliation(s)
- Ebru Karakaya Gojayev
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| | | | - Tuğba Akyüz
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| | - Mustafa Rehan
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| | - Gürsel Dursun
- Department of Otorhinolaryngology, Ankara University, Medical School, Ankara, Turkey
| |
Collapse
|
29
|
Nampoolsuksan C, Akaraviputh T, Methasate A, Swangsri J, Trakarnsanga A, Phalanusitthepha C, Parakonthun T, Taweerutchana V, Srisuworanan N, Suwatthanarak T, Tawantanakorn T, Lohsiriwat V, Chinswangwatanakul V. Aerosol protection using modified N95 respirator during upper gastrointestinal endoscopy: a randomized controlled trial. Clin Endosc 2024; 57:335-341. [PMID: 37430403 PMCID: PMC11133990 DOI: 10.5946/ce.2023.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND/AIMS The coronavirus disease 2019 pandemic has affected the worldwide practice of upper gastrointestinal endoscopy. Here we designed a modified N95 respirator with a channel for endoscope insertion and evaluated its efficacy in upper gastrointestinal endoscopy. METHODS Thirty patients scheduled for upper gastrointestinal endoscopy were randomized into the modified N95 (n=15) or control (n=15) group. The mask was placed on the patient after anesthesia administration and particles were counted every minute before (baseline) and during the procedure by a TSI AeroTrak particle counter (9306-04; TSI Inc.) and categorized by size (0.3, 0.5, 1, 3, 5, and 10 µm). Differences in particle counts between time points were recorded. RESULTS During the procedure, the modified N95 group displayed significantly smaller overall particle sizes than the control group (median [interquartile range], 231 [54-385] vs. 579 [213-1,379]×103/m3; p=0.056). However, the intervention group had a significant decrease in 0.3-µm particles (68 [-25-185] vs. 242 [72-588]×103/m3; p=0.045). No adverse events occurred in either group. The device did not cause any inconvenience to the endoscopists or patients. CONCLUSIONS This modified N95 respirator reduced the number of particles, especially 0.3-µm particles, generated during upper gastrointestinal endoscopy.
Collapse
Affiliation(s)
- Chawisa Nampoolsuksan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thawatchai Akaraviputh
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Asada Methasate
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jirawat Swangsri
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Atthaphorn Trakarnsanga
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Thammawat Parakonthun
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Voraboot Taweerutchana
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nicha Srisuworanan
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tharathorn Suwatthanarak
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | |
Collapse
|
30
|
Phelan J, Thangamuthu A, Muthumeenal S, Houston K, Everton M, Gowda S, Zhang J, Subramanian R. Vital D: A modifiable occupational risk factor of UK healthcare workers. PLoS One 2024; 19:e0296247. [PMID: 38625871 PMCID: PMC11020869 DOI: 10.1371/journal.pone.0296247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 12/10/2023] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND The role of Vitamin D in immune function is well reported with a growing evidence base linking low levels to poorer outcomes from infectious disease. Vitamin D deficiency and insufficiency are prevalent worldwide with healthcare workers identified as a known at-risk group. Here we aim to investigate serum Vitamin D levels in a UK population of front line healthcare workers and to promote the occupational risk. METHODS A cross-sectional study of 639 volunteers was conducted to identify the prevalence of Vitamin D deficiency and insufficiency amongst a population of front-line health care workers in the UK. Participant demographics and co-morbid factors were collected at the time of serum sampling for multivariate analysis. RESULTS Only 18.8% of the population had a normal vitamin D level greater than or equal to 75nmol/L. This is compared to Public Health England's (PHE) stipulated normal levels of 60% during winter. 81.2% had a level less than 75nmol/L, with 51.2% less than 50nmol/L and 6.6% less than 25nmol/L. For serum levels less than 25nmol/L, Asian ethnicity was more likely to have a vitamin D deficiency than non-asian (OR (95%CI): 3.81 (1.73-8.39), p = 0.001), whereas white ethnicity was less likely to have a vitamin D deficiency compared to non-white (OR (95%CI: 0.43 (0.20-0.83), p = 0.03). Other factors that contributed to a higher likelihood of lower-than-normal levels within this population included male sex, decreased age and not taking supplementation. CONCLUSION It is concluded that our population of healthcare workers have higher rates of abnormal vitamin D levels in comparison with the general UK population reported prevalence. Furthermore, Asian ethnicity and age 30 years and below are more at risk of vitamin D insufficiency and deficiency. This highlights an occupational risk factor for the healthcare community to consider.
Collapse
Affiliation(s)
- James Phelan
- Basildon Hospital, Mid and South Essex Foundation Trust, Basildon, United Kingdom
| | | | | | - Kirsteen Houston
- Southend Hospital, Mid and South Essex Foundation Trust, Westcliff-on-Sea, United Kingdom
| | - Mark Everton
- Basildon Hospital, Mid and South Essex Foundation Trust, Basildon, United Kingdom
| | - Sathyanarayana Gowda
- Basildon Hospital, Mid and South Essex Foundation Trust, Basildon, United Kingdom
| | - Jufen Zhang
- School of Medicine, Faculty of Health Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, United Kingdom
| | | |
Collapse
|
31
|
Briones-Claudett KH, Briones-Claudett MH, Bajaña Huilcapi CK, Tripul Villamar OE, Ochoa Vásquez R, Rivera Salas CDR, Briones-Zamora KH, Benites Solis J, Briones-Márquez DC, Freire AX, Grunauer M. Surfactant therapy using vibrating-mesh nebulizers in adults with COVID-19-induced ARDS: A case series. SAGE Open Med Case Rep 2024; 12:2050313X241236313. [PMID: 38444695 PMCID: PMC10913513 DOI: 10.1177/2050313x241236313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
Coronavirus adult respiratory distress syndrome, characterized by decreased surfactant due to lysis of type II pneumocytes and hyaline membrane formation, contributes to severe hypoxemia. The administration of surfactant via high-flow nasal cannula (HFNC) may positively affect lung structure and function in this context. In this study, we report on five clinical cases, encompassing patients aged 40-60 years of both sexes, who tested positive for coronavirus disease 2019 via real-time polymerase chain reaction and exhibited significant pulmonary compromise with elevated inflammatory biomarkers. These patients were treated with aerosol therapy using surfactant delivered through vibrating-mesh nebulizers alongside HFNC. Of these patients, four demonstrated positive responses to the treatment, suggesting that aerosol therapy with surfactant through vibrating-mesh nebulizers could be a viable rescue therapy in adults receiving HFNC oxygen therapy for hypoxemic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, one patient had a negative outcome and succumbed. The findings from these cases indicate that the use of aerosol therapy with vibrating-mesh nebulizers as rescue therapy might offer an alternative approach for managing adults with hypoxemic respiratory failure due to SARS-CoV-2, as evidenced by the positive outcomes in four out of the five cases presented.
Collapse
Affiliation(s)
- Killen H Briones-Claudett
- Facultad de Medicina, Universidad de Las Americas, Quito, Ecuador
- Intensive Care Unit, Ecuadorian Institute of Social Security, Babahoyo, Ecuador
| | | | | | | | | | | | | | | | | | - Amado X Freire
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michelle Grunauer
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| |
Collapse
|
32
|
Díaz F, Cruces P. Airway Management of Critically Ill Pediatric Patients with Suspected or Proven Coronavirus Disease 2019 Infection: An Intensivist Point of View. J Pediatr Intensive Care 2024; 13:1-6. [PMID: 38571985 PMCID: PMC10987222 DOI: 10.1055/s-0041-1732345] [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: 05/08/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022] Open
Abstract
Advanced airway management of critically ill children is crucial for novel coronavirus disease 2019 (COVID-19) management in the pediatric intensive care unit, whether due to shock and hemodynamic collapse or acute respiratory failure. In this article, intubation is challenging due to the particularities of children's physiology and the underlying disease's pathophysiology, especially when an airborne pathogen, like COVID-19, is present. Unfortunately, published recommendations and guidelines for COVID-19 in pediatrics do not address in-depth endotracheal intubation in acutely ill children. We discussed the caveats and pitfalls of intubation in critically ill children.
Collapse
Affiliation(s)
- Franco Díaz
- Unidad de Paciente Crítico Pediátrico, Hospital el Carmen de Maipú, Santiago, Chile
- Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
| | - Pablo Cruces
- Unidad de Paciente Crítico Pediátrico, Hospital el Carmen de Maipú, Santiago, Chile
- Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Santiago, Chile
- Centro de Investigación de Medicina Veterinaria, Escuela de Medicina Veterinaria, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| |
Collapse
|
33
|
Nourouzpour N, Jen TTH, Bailey J, Jobin PG, Sutherland JM, Ho CM, Prabhakar C, Ke JXC. Association between anesthesia technique and death after hip fracture repair for patients with COVID-19. Can J Anaesth 2024; 71:367-377. [PMID: 38129357 DOI: 10.1007/s12630-023-02673-2] [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: 06/27/2023] [Revised: 08/26/2023] [Accepted: 09/18/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Patients with COVID-19 undergoing hip fracture surgeries have a 30-day mortality of up to 34%. We aimed to evaluate the association between anesthesia technique and 30-day mortality after hip fracture surgery in patients with COVID-19. METHODS After ethics approval, we performed a retrospective cohort analysis of the American College of Surgeons National Surgical Quality Improvement Program data set from January to December 2021. Inclusion criteria were age ≥ 19 yr, laboratory-confirmed SARS-CoV-2 infection within 14 days preoperatively, and hip fracture surgery under general anesthesia (GA) or spinal anesthesia (SA). Exclusion criteria were American Society of Anesthesiologists Physical Status V, ventilator dependence, international normalized ratio ≥ 1.5, partial thromboplastin time > 35 sec, and platelet count < 80 × 109 L-1. The primary outcome was all-cause 30-day mortality. The adjusted association between anesthetic technique and 30-day mortality was analyzed using multivariable logistic regression. RESULTS Of 23,045 patients undergoing hip fracture surgery, 331 patients met the study criteria. The median [interquartile range] age was 82 [74-88] yr, and 32.3% were male. The 30-day mortality rate was 10.0% (33/331) for the cohort (10.7%, 29/272 for GA vs 6.8%, 4/59 for SA; P = 0.51; standardized mean difference, 0.138). The use of SA, compared with GA, was not associated with decreased mortality (adjusted odds ratio, 0.61; 95% confidence interval, 0.21 to 1.8; E-value, 2.49). CONCLUSION Anesthesia technique was not associated with mortality in patients with COVID-19 undergoing hip fracture surgery. The findings were limited by a small sample size. STUDY REGISTRATION www. CLINICALTRIALS gov (NCT05133648); registered 24 November 2021.
Collapse
Affiliation(s)
- Nilufer Nourouzpour
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Tim T H Jen
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Jonathan Bailey
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Parker G Jobin
- Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Chun-Man Ho
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Christopher Prabhakar
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Janny X C Ke
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
- Department of Anesthesiology, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
- Department of Anesthesia, St. Paul's Hospital, Providence Health Care, Third Floor, Providence Building, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|
34
|
Hey HWD, Tay HW, Bosco A, Soh RCC, Oh JYL. Impact of COVID-19 on orthopaedic specialist training: a nationwide survey of orthopaedic residents in Singapore. Singapore Med J 2024; 65:S56-S62. [PMID: 35083908 PMCID: PMC11073654 DOI: 10.11622/smedj.2022013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 04/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Hwee Weng Dennis Hey
- Department of Orthopaedic Surgery, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Wen Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Aju Bosco
- Orthopaedic Spine Surgery Unit, Madras Medical College and Research Institute, Chennai, Tamil Nadu, India
| | | | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| |
Collapse
|
35
|
Leong WGR, Tan JL, Chong YK. Impact of COVID-19 on an otorhinolaryngology residency training programme in Singapore: a quantitative and qualitative study. Singapore Med J 2024; 65:S63-S65. [PMID: 35650715 PMCID: PMC11073661 DOI: 10.11622/smedj.2022061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Wen Ge Rachel Leong
- Department of Otorhinolaryngology - Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Jian Li Tan
- Department of Otorhinolaryngology - Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, National Technological University–Imperial College London, Singapore
| | - Yaw Khian Chong
- Department of Otorhinolaryngology - Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, National Technological University–Imperial College London, Singapore
| |
Collapse
|
36
|
Srivastava A, Ahmad R, Wani IA, Siddiqui S, Yadav K, Trivedi A, Upadhyay S, Husain I, Ahamad T, Dudhagi SS. Steroidal lactones from Withania somnifera effectively target Beta, Gamma, Delta and Omicron variants of SARS-CoV-2 and reveal a decreased susceptibility to viral infection and perpetuation: a polypharmacology approach. In Silico Pharmacol 2024; 12:14. [PMID: 38419919 PMCID: PMC10897645 DOI: 10.1007/s40203-023-00184-y] [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: 01/06/2023] [Accepted: 12/14/2023] [Indexed: 03/02/2024] Open
Abstract
Prevention from disease is presently the cornerstone of the fight against COVID-19. With the rapid emergence of novel SARS-CoV-2 variants, there is an urgent need for novel or repurposed agents to strengthen and fortify the immune system. Existing vaccines induce several systemic and local side-effects that can lead to severe consequences. Moreover, elevated cytokines in COVID-19 patients with cancer as co-morbidity represent a significant bottleneck in disease prognosis and therapy. Withania somnifera (WS) and its phytoconstituent(s) have immense untapped immunomodulatory and therapeutic potential and the anticancer potential of WS is well documented. To this effect, WS methanolic extract (WSME) was characterized using HPLC. Withanolides were identified as the major phytoconstituents. In vitro cytotoxicity of WSME was determined against human breast MDA-MB-231 and normal Vero cells using MTT assay. WSME displayed potent cytotoxicity against MDA-MB-231 cells (IC50: 66 µg/mL) and no effect on Vero cells in the above range. MD simulations of Withanolide A with SARS-CoV-2 main protease and spike receptor-binding domain as well as Withanolide B with SARS-CoV spike glycoprotein and SARS-CoV-2 papain-like protease were performed using Schrödinger. Stability of complexes followed the order 6M0J-Withanolide A > 6W9C-Withnaolide B > 5WRG-Withanolide B > 6LU7-Withanolide A. Maximum stable interaction(s) were observed between Withanolides A and B with SARS-CoV-2 and SARS-CoV spike glycoproteins, respectively. Withanolides A and B also displayed potent binding to pro-inflammatory markers viz. serum ferritin and IL-6. Thus, WS phytoconstituents have the potential to be tested further in vitro and in vivo as novel antiviral agents against COVID-19 patients having cancer as a co-morbidity. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s40203-023-00184-y.
Collapse
Affiliation(s)
- Aditi Srivastava
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Rumana Ahmad
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Irshad A. Wani
- Department of Cardiology, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Sahabjada Siddiqui
- Department of Biotechnology, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Kusum Yadav
- Department of Biochemistry, University of Lucknow, Lucknow, UP 226007 India
| | - Anchal Trivedi
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Shivbrat Upadhyay
- Department of Biotechnology, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Ishrat Husain
- Department of Biochemistry, Era’s Lucknow Medical College & Hospital, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Tanveer Ahamad
- Department of Biotechnology, Era University, Sarfarazganj, Hardoi Road, Lucknow, UP 226003 India
| | - Shivanand S. Dudhagi
- Plant Physiology Laboratory, CSIR-National Botanical Research Institute, Lucknow, UP 226001 India
| |
Collapse
|
37
|
Buratti CR, Veillette M, Bridier A, Aubin CE, Lebrun M, Ammaiyappan AK, Vanoli E, Crawford C, Duchaine C, Jouvet P. Effectiveness of SplashGuard Caregiver prototype in reducing the risk of aerosol transmission in intensive care unit rooms of SARS-CoV-2 patients: a prospective and simulation study. J Hosp Infect 2024; 144:75-84. [PMID: 38040038 DOI: 10.1016/j.jhin.2023.11.007] [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: 09/06/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND The contagiousness of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is known to be linked to the emission of bioaerosols. Thus, aerosol-generating procedures (AGPs) could increase the risk of infection among healthcare workers (HCWs). AIM To investigate the impact of an aerosol protection box, the SplashGuard Caregiver (SGGC) with suction system, by direct analysis of the presence of viral particles after an AGP, and by using the computational fluid dynamics (CFD) simulation method. METHODS This prospective observational study investigated HCWs caring for patients with SARS-CoV-2 admitted to an intensive care unit (ICU). Rooms were categorized as: SGCG present and SGCG absent. Virus detection was performed through direct analysis, and using a CFD model to simulate the movement dynamics of airborne particles produced by a patient's respiratory activities. FINDINGS Of the 67 analyses performed, three samples tested positive on quantitative polymerase chain reaction: one of 33 analyses in the SCCG group (3%) and two of 34 analyses in the non-SGCG group (5.9%). CFD simulations showed that: (1) reduction of the gaps of an SGCG could decrease the number of emitted particles remaining airborne within the room by up to 70%; and (2) positioning HCWs facing the opposite direction to the main air flow would reduce their exposure. CONCLUSIONS This study documented the presence of SARS-CoV-2 among HCWs in a negative pressure ICU room of an infected patient with or without the use of an SGCG. The simulation will help to improve the design of the SGCG and the positioning of HCWs in the room.
Collapse
Affiliation(s)
- C R Buratti
- Pediatric Intensive Care Unit, Department of Pediatrics, Hospital da Criança Santo Antônio, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - M Veillette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - A Bridier
- Paediatric Intensive Care, Department of Paediatrics, Purpan Hospital, University of Toulouse, Toulouse, France
| | - C E Aubin
- Polytechnique Montreal, University Hospital Centre Sainte-Justine, Montréal, Québec, Canada
| | - M Lebrun
- Dassault Systèmes Simulia Corporation, Vélizy-Villacoublay, France
| | | | - E Vanoli
- Dassault Systèmes Simulia Corporation, Vélizy-Villacoublay, France
| | - C Crawford
- Dassault Systèmes Simulia Corporation, Vélizy-Villacoublay, France
| | - C Duchaine
- Université Laval, Québec, Québec, Canada
| | - P Jouvet
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Centre Sainte-Justine, Montréal, Québec, Canada.
| |
Collapse
|
38
|
Ahn C, Park Y, Oh Y. Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis. Acute Crit Care 2024; 39:179-185. [PMID: 38476070 PMCID: PMC11002625 DOI: 10.4266/acc.2023.01165] [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: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. METHODS A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables. RESULTS In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001). CONCLUSIONS Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.
Collapse
Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoonseok Oh
- Data engineer, SciAL Tech Inc., Seoul, Korea
| |
Collapse
|
39
|
Wilson NM, Calabria C, Warren A, Finlay A, O'Donovan A, Passerello GL, Ribaric NL, Ward P, Gillespie R, Farrel R, McNarry AF, Pan D. Quantifying hospital environmental ventilation using carbon dioxide monitoring - a multicentre study. Anaesthesia 2024; 79:147-155. [PMID: 38059394 DOI: 10.1111/anae.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
Collapse
Affiliation(s)
- N M Wilson
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Calabria
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Warren
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Finlay
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A O'Donovan
- Department of Process, Energy and Transport Engineering, MeSSO Research Group, Munster Technological University, Cork, Ireland
| | - G L Passerello
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - N L Ribaric
- Faculty of Medicine, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - P Ward
- Department of Anaesthesia, St John's Hospital, Livingston, UK
| | - R Gillespie
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Farrel
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A F McNarry
- Department of Anaesthesia, Western General Hospital, UK
| | - D Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
40
|
Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
Collapse
Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| |
Collapse
|
41
|
Modjo R, Lestari F, Tanjung H, Kadir A, Putra RS, Rahmadani M, Chaeruman AS, Lestari F, Sutanto J. COVID-19 infection prevention and control for hospital workers in Indonesia. Front Public Health 2024; 11:1276898. [PMID: 38259732 PMCID: PMC10800904 DOI: 10.3389/fpubh.2023.1276898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction The outbreak of SARS-CoV-2 in 2019 led to a global pandemic, posing unprecedented challenges to healthcare systems, particularly in hospitals. Purpose This study explores the intricacies of strategies employed for preventing and controlling COVID-19 in Indonesian hospitals, with a particular focus on the protocols, challenges, and solutions faced by healthcare professionals. Methods Using a cross-sectional analysis, we examined 27 hospitals and uncovered disparities in their preparedness levels. During our investigation, we observed the robust implementation of infection prevention measures, which encompassed stringent protocols, adequate ventilation, and proper use of personal protective equipment. However, shortcomings were identified in areas such as surveillance, mental health support, and patient management. Discussion This study underscores the importance of addressing these gaps, suggesting tailored interventions, and continuous training for healthcare staff. Effective leadership, positive team dynamics, and adherence to comprehensive policies emerge as pivotal factors. Hospitals should strengthen weak areas, ensure the ethical execution of emergency protocols, and integrate technology for tracking and improving standard operating procedures. By enhancing the knowledge and skills of healthcare workers and maintaining strong management practices, hospitals can optimize their efforts in COVID-19 prevention and control, thereby safeguarding the wellbeing of professionals, patients, and communities.
Collapse
Affiliation(s)
- Robiana Modjo
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
| | - Fatma Lestari
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Disaster Risk Reduction Center, Universitas Indonesia, Depok, West Java, Indonesia
| | - Hendra Tanjung
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
| | - Abdul Kadir
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | | | - Meilisa Rahmadani
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
- Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | | | - Fetrina Lestari
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
| | - Juliana Sutanto
- Department of Human Centred Computing, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
42
|
Aktas FO, Turhan Damar H, Ozkul B, Voight P, Guckian Fisher M, Elin M, Sharma SK, Bird S. Predictors of anxiety and depression in operating room nurses during the COVID-19 pandemic: A multi-center cross-sectional study. Work 2024; 78:279-293. [PMID: 38189725 DOI: 10.3233/wor-230207] [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] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Operating room nurses (ORNs) who directly deal with the treatment and care of COVID-19 patients during the pandemic are at risk in terms of psychological stress and other mental health problems. OBJECTIVE The aim of the study was to compare the anxiety and depression levels of ORNs working in different countries in the COVID-19 outbreak, and to determine the predictors and the difference between countries. METHODS This was a descriptive and cross-sectional study. Data were collected online using a google form between February 2021-February 2022. The universe of the research is nurses who are members of national Perioperative Nurses Association (USA, Türkiye, Australia, England, India, Israel) and 1127 ORNs participated the study. In multivariate analysis, independent predictors of anxiety and depression status were examined by binary logistic regression analysis. RESULTS The rate of anxiety is 5.46 times higher in nurses in the USA, 5.07 times higher among nurses in Australia, and 4.49 times higher for nurses in England. It was determined that the rate of depression in ORNs working in Türkiye was 5.97 times higher. It was found that the rate of depression is 1.59 times higher in ORNs living away from the family after care of COVID-19 patient. CONCLUSION Despite some differences between countries in terms of health system, patient potential, economic and the opportunities offered, generally high levels of anxiety and/or depression indicate that all ORNs need urgent support. Identifying risk factors will help recognize anxiety and depression in ORNs and take measures to protect their mental health during the pandemic.
Collapse
Affiliation(s)
- Filiz Ogce Aktas
- Department of Nursing, Faculty of Health Sciences, Izmir University of Economics, Izmir, Turkey
| | - Hale Turhan Damar
- Eldery Care Program, Health Services Vocational School, Izmir Democracy University, Izmir, Turkey
| | - Burcu Ozkul
- The Alfred Clinical School, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | | | | | | | | | - Sarah Bird
- International Federation of Perioperative Nurses, Acton Park, Australia
| |
Collapse
|
43
|
Dost A, Sezgin D, Esin MN. The association between the work environment and the fear of COVID-19 experienced by nurses. Work 2024; 79:3-13. [PMID: 38427519 DOI: 10.3233/wor-230121] [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] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND The conditions in the workplace have a critical influence on the mental health of nurses and their attitudes toward their job, which may impact patient care. OBJECTIVE This cross-sectional study aimed to investigate the association between perceptions of the work environment and fear of COVID-19 experienced by nurses. METHODS The data were collected using a demographic data form, the Work Environment Scale (WES), and the Fear of COVID-19 Scale. The study was completed with 183 nurses who provide care to COVID-19 patients. RESULTS The mean scores for the WES and Fear of COVID-19 Scale were 63.59±12.35 and 21.98±8.36, respectively. There was a positive correlation between the points acquired from the "employee fears" section of the WES and the Fear of COVID-19 Scale mean ranks (r = 0.22). There was a weak negative correlation between the Fear of COVID-19 score and the WES "job satisfaction" score (r = -0.214). There was a weak negative correlation between the scores of the Fear of COVID-19 Scale and perceived support at work (r = -0.33) and between the WES scores and weekly working hours (r = -0.27). However, there was a weak to moderate positive correlation between the WES scores and number of days off per week (r = 0.45). CONCLUSIONS Nurses experience a high fear of COVID-19, and a decrease in their attitudes of the work environment was associated with an increased fear of COVID-19. The fear of COVID-19 may be reduced by various interventions to provide support at work and increase nurses' job satisfaction.
Collapse
Affiliation(s)
- Ayse Dost
- Department of Nursing, Health Sciences Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland - Galway, Galway, Ireland
| | - Melek Nihal Esin
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
44
|
Ghosh A, Sanyal A, Mitra P, Dey T, Acharjee A, Pattnaik R, Nesa L. Transmission mechanism and clinical manifestations of SARS-CoV-2. DIAGNOSIS AND ANALYSIS OF COVID-19 USING ARTIFICIAL INTELLIGENCE AND MACHINE LEARNING-BASED TECHNIQUES 2024:65-96. [DOI: 10.1016/b978-0-323-95374-0.00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
|
45
|
Lu K, Wu W, Jin G, Yang H, Cai X, Li L, Chen Z, Ren L, Guo B, Xue QF. Application of a New Type of Protective Sputum Suction Device in Clinic against Cross-Infection between Medical Staff and Patients. Crit Care Res Pract 2023; 2023:9927819. [PMID: 38187985 PMCID: PMC10771915 DOI: 10.1155/2023/9927819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To explore the clinical application of a new type of protective sputum suction device (PSSD) in patients with tracheotomy or tracheal intubation and to evaluate the protective effect of PSSD against cross-infection between medical staffs and patients. Methods A novel PSSD was designed which can assist closed sputum suction operation without disconnecting the ventilator. 32 patients with tracheotomy were included to study the protective effect and safety of this device. Patients' vital signs including heart rate, respiratory rate, mean arterial pressure, and blood oxygen saturation were recorded to compare the influence of open suction and closed suction (performed with this novel device). To verify the antisplash effect of this device on airway secretions, bacterial samples were collected from the hands of the suction operators and the environment near the endotracheal tube orifice before and after the two suction processes. In addition, the satisfaction of the two suction methods was compared through the questionnaire of suction staff. Finally, with the assistance of this device, an attempt was made to complete the bronchoscopy without weaning of ventilator. Results Compared with open sputum suction, closed sputum suction has a smaller decrease in patients' blood oxygen saturation (P < 0.05), and no significant differences in other vital signs. Compared with open sputum suction, bacteria from the hands of suction staffs and the surrounding environment of the endotracheal tube were barely detected in closed suction. A questionnaire survey of sputum suction nurses suggested that the satisfaction with use and protective effect of the closed suction were better than open suction. In addition, bronchoscopy can be successfully completed with the assistance of this device, which is not possible for other breathing tubes. Conclusion This closed sputum suction device has little effect on the oxygen saturation of patients but has excellent protective effects for medical staff against cross-infection. It has a unique advantage that can assist in completing the fiberoptic bronchoscopy with continuous ventilator-assisted breathing.
Collapse
Affiliation(s)
- Kang Lu
- Cadre Ward Department, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Weizhou Wu
- Neurology Department, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Gaomei Jin
- Neurology Department, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Haixia Yang
- Neurology Department, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Xiaowei Cai
- Dermatology Department, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Lin Li
- Clinical Laboratory, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Zanchao Chen
- Disease Prevention Department, the 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Lin Ren
- Hematology and Oncology Department, The 985th Hospital of the Joint Logistics Support Force, Taiyuan, China
| | - Baoshuan Guo
- Henan Di Yi Medical Technology Development Co., Ltd., Changyuan Country, Xinxiang City, Henan 453400, China
| | - Qing-feng Xue
- Anesthesiology Department, The 985th Hospital of the Joint Logistics Support Force, Qiaodong Road No. 30, Taiyuan 030001, China
| |
Collapse
|
46
|
Taniguchi K, Tsutsumiuchi K, Sagara Y, Tayama N. Prevention of cuff injury of the intubation tube by blunt window opening in tracheostomy. Glob Health Med 2023; 5:381-384. [PMID: 38162431 PMCID: PMC10730918 DOI: 10.35772/ghm.2023.01003] [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: 01/18/2023] [Revised: 09/15/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
One of the intraoperative complications of tracheostomy under general anesthesia is cuff injury of the intubation tube. In the present study, we investigated whether a blunt tracheal opening is a useful method to avoid cuff injury. A retrospective cohort study was conducted to examine patients who underwent tracheostomy under general anesthesia at a single institution from January 1, 2017 to July 31, 2021. Electrocautery was used to thin the connective tissue between the tracheal rings, and bluntly open the trachea with mosquito forceps or similar instruments. Primary outcomes included cuff injury rate, number of surgeons involved, and career as otolaryngologist at the time of surgery. The secondary outcome was perioperative complications. Of the 64 cases, 3 had cuff injuries. 2 of the 3 had cuff injuries during the creation of an anteriorly based flap. 16 surgeons were involved ranging from the first to sixth year as an otolaryngologist, with the third year of otolaryngologist being the most common. The median physician year for instructors was 18 years. The most common postoperative complication was granulation in 9 cases. There were no cases of incorrect cannula insertion or difficulty in cannula insertion. A blunt tracheal opening was considered useful as a method to prevent cuff injury.
Collapse
Affiliation(s)
- Kenshiro Taniguchi
- Department of Otolaryngology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Katsuhiro Tsutsumiuchi
- Department of Otolaryngology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukiko Sagara
- Department of Otolaryngology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
47
|
Wang J, Liu Y, Chen L, Liu Y, Mi K, Gao S, Mao J, Zhang H, Sun Y, Ma Z. Validation and calibration of aerosol optical depth and classification of aerosol types based on multi-source data over China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 903:166603. [PMID: 37660811 DOI: 10.1016/j.scitotenv.2023.166603] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
A refined classification of aerosol types is essential to identify and control air pollution sources. This study focused on improving the resolution and accuracy of aerosol optical depth (AOD) and further refining the classification of aerosol types in China. We validated the accuracy of the AOD acquired using the Modern-Era Retrospective Analysis for Research and Applications version 2 (MERRA2) and Copernicus Atmosphere Monitoring Service (CAMS) by comparing it with that acquired using from the Aeronet Robotic Network (AERONET). We simulated the AOD with high spatial resolution and accuracy based on the extremely randomized trees (ERT), adaptive boosting (AdaBoost), and gradient boosting decision trees (GBDT) models and identified aerosol types based on the Angstrom Exponent (AE) from the Moderate Resolution Imaging Spectroradiometer (MODIS) and the calibrated AOD. The results showed that CAMS overestimates AOD (21.4 %) and MERRA2 underestimates AOD (-17.3 %). Among the three machine learning models, the ERT model performed best, with a determination coefficient (R2) of 0.825 and the root-mean-square error (RMSE) of 0.174. Biomass burning/urban-industrial aerosols dominated China, with the largest contributions to southern, eastern, and central China in spring and summer. Clean continental aerosols contributed the most to southwestern China in fall and winter, whereas desert dust aerosols contributed the most to northwestern and eastern China in spring.
Collapse
Affiliation(s)
- Jing Wang
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Yusi Liu
- State Key Laboratory of Severe Weather & Key Laboratory for Atmospheric Chemistry of China Meteorology Administration, Chinese Academy of Meteorological Sciences, Beijing 100081, China
| | - Li Chen
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China.
| | - Yaxin Liu
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Ke Mi
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Shuang Gao
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Jian Mao
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Hui Zhang
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Yanling Sun
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| | - Zhenxing Ma
- School of Geographic and Environmental Sciences, Tianjin Normal University, Tianjin 300387, China
| |
Collapse
|
48
|
Nelson O, Greenwood E, Simpao AF, Matava CT. Refocusing on work-based hazards for the anaesthesiologist in a post-pandemic era. BJA OPEN 2023; 8:100234. [PMID: 37942056 PMCID: PMC10630594 DOI: 10.1016/j.bjao.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.
Collapse
Affiliation(s)
- Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Eric Greenwood
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan F. Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
49
|
Fayed M, Maroun W, Patel N, Galusca D. Apneic Oxygenation: A Summarized Review and Stepwise Approach. Cureus 2023; 15:e50916. [PMID: 38249244 PMCID: PMC10799750 DOI: 10.7759/cureus.50916] [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] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Apneic oxygenation is a technique used during airway management procedures to maintain oxygenation and prevent desaturation during a lack of ventilation. Despite its importance, there is a lack of comprehensive information on how to achieve effective apneic oxygenation, leading to misunderstandings and suboptimal utilization of this technique. Apneic oxygenation involves several key steps. Firstly, patient selection is crucial, considering factors such as anticipated difficulty with airway management, reduced functional residual capacity, increased oxygen consumption, and medical conditions associated with impaired oxygenation. Secondly, adequate preoxygenation is essential to optimize oxygen reserves before the onset of apnea, utilizing methods like non-rebreather oxygen masks or specific breathing techniques. Thirdly, maintaining airway patency through techniques such as jaw thrust or nasopharyngeal airway placement allows for unobstructed airflow during the apneic period. Lastly, the selection of the appropriate oxygen delivery method, such as high-flow nasal oxygen or nasal cannula, depends on the patient's existing respiratory support. Despite the growing body of literature on apneic oxygenation, current review articles often lack a stepwise approach for its proper execution. This knowledge gap contributes to the misunderstanding and underutilization of this important tool during intubation and airway management. In conclusion, apneic oxygenation is a valuable technique for maintaining oxygenation during periods of apnea. However, the lack of comprehensive information and stepwise guidance in the current literature hinders its optimal utilization. Clear guidelines and educational resources should be developed to address this knowledge gap and ensure the safe and effective implementation of apneic oxygenation. By following a stepwise approach that includes patient selection, adequate preoxygenation, airway patency, and appropriate oxygen delivery, healthcare providers can enhance patient outcomes and minimize the risk of desaturation during airway management procedures.
Collapse
Affiliation(s)
- Mohamed Fayed
- Cardiothoracic Anesthesia, Montefiore Medical Center, Bronx, USA
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Wissam Maroun
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Nimesh Patel
- Anesthesiology, Pain Management and Perioperative Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dragos Galusca
- Anesthesia and Critical Care, Henry Ford Health System, Detroit, USA
| |
Collapse
|
50
|
Dhanak M, Verma S, Hughes PG, Ching AL, Lo A, Clay C, McKinney A, Frankenfield J. The Laboratory Characterization of Fugitive Aerosol Emissions From a Standard Jet Nebulizer With and Without a Filtered Mouthpiece. Cureus 2023; 15:e50611. [PMID: 38226095 PMCID: PMC10788659 DOI: 10.7759/cureus.50611] [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: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Background and objective The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from patients with coronavirus disease 2019 (COVID-19) during nebulization is unclear. In this study, we aimed to address this issue. Methods Fugitive emissions of aerosolized saline during nebulization were observed using a standard jet nebulizer fitted with unfiltered and filtered mouthpieces connected via a mannequin to a breathing simulator. Fugitive emissions were observed by using a laser sheet and captured on high-definition video, and they were measured by using optical particle counters positioned where a potential caregiver may be administering nebulization and three other locations in the sagittal plane at various distances downstream of the mannequin. Results The use of a standard unfiltered mouthpiece resulted in significant emission of fugitive aerosols ahead of and above the mannequin (spread over 2 m in front). A mouthpiece with a filter-adaptor effectively suppressed the emissions, with only minor leakage from the nebulizer cup. Particle count measurements supported the visual observations, providing total particle count levels and aerosol concentration levels at the measurement locations. The levels decayed slowly with downstream distance. Conclusions The visualization described above captured the dispersion of emitted aerosols in the plane of the laser sheet, aligned with the sagittal plane. The particle count measurements provided temporal and spatial distributions of the aerosol concentration levels over the time and locations considered. However, the exhaled air and aerosolized droplets spread three-dimensionally in front of and above the mannequin. The results visually highlight the effectiveness of using a filtered mouthpiece in suppressing the fugitive aerosols and identify an approach for limiting the occupational exposure of healthcare workers to these emissions while administering nebulized therapies.
Collapse
Affiliation(s)
- Manhar Dhanak
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| | - Siddhartha Verma
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| | - Patrick G Hughes
- Emergency Medicine, Florida Atlantic University, Boca Raton, USA
| | - Ai Ling Ching
- Medical Affairs, Theravance Biopharma US, Inc., South San Francisco, USA
| | - Arthur Lo
- Medical Affairs, Theravance Biopharma US, Inc., South San Francisco, USA
| | - Candice Clay
- Medical Affairs, Theravance Biopharma US, Inc., South San Francisco, USA
| | - Adriana McKinney
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| | - John Frankenfield
- Department of Ocean and Mechanical Engineering, Florida Atlantic University, Boca Raton, USA
| |
Collapse
|