Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy

Bertroche, J. Tyler; Pipkorn, Patrik; Zolkind, Paul; Buchman, Craig A.; Zevallos, José P.

doi:10.1001/jamaoto.2020.1081

Cited by 39 publications

(66 citation statements)

References 6 publications

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“…There were 19 correspondences, 4e22 16 letters to the editor, 23e33,35e39 10 original articles, 40e49 three research letters, 34,50,51 one guideline, 52 one short recommendation, 53 one case report, 54 and one quality improvement study. 55 Of these reports, there were only six case reports or small case series. 6,15,42e44,54 The most common barrier-enclosure types were plastic wraps or tents (25 reports), 5,9,12,15,17,23e29,31,33,34,38,39,41,42,44,46,47,52,54,56 acrylic aerosol boxes (19 reports), 4e6,8,11,15,16,18,19,22,24,35,36,43,45,51,53,57,58 and combinations of aerosol boxes and plastic wraps (eight reports).…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…6,15,42e44,54 The most common barrier-enclosure types were plastic wraps or tents (25 reports), 5,9,12,15,17,23e29,31,33,34,38,39,41,42,44,46,47,52,54,56 acrylic aerosol boxes (19 reports), 4e6,8,11,15,16,18,19,22,24,35,36,43,45,51,53,57,58 and combinations of aerosol boxes and plastic wraps (eight reports). 6,8,13,15,32,37,43,49 Eleven reports included other types of barrier enclosures (modified incubator hood, 7 carton box, 8 acrylic panels, 50 surgical retractors, frames and anaesthetic poles, 21,42,44,48 external fixators, 14 suspension laryngoscopy support, 41,55 and modified packaging tray 40 ). In 10 cases, a smoke evacuator/aspirator was reported.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

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Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Sorbello

Rosenblatt

Hofmeyr

et al. 2020

British Journal of Anaesthesia

113

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Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/ confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fiftytwo articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.

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Section: Characteristics Of Studiesmentioning

confidence: 99%

Section: Characteristics Of Studiesmentioning

confidence: 99%

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Sorbello

Rosenblatt

Hofmeyr

et al. 2020

British Journal of Anaesthesia

113

View full text Add to dashboard Cite

show abstract

“…Additionally, asymptomatic and pre-symptomatic SARS-CoV-2 transmission mandate precautionary measures like that to reduce viral spread [ 7 ]. Similar barrier techniques were already proposed and successfully used in other airway procedures during the COVID era, highlighting the fact that ENT surgeons have appreciated the importance of aerosol mitigation during ENT procedures [ 8 – 10 ]. Our method allowed for unrestricted hand movements and there was not any interference in the visualisation of the surgical field e.g., glaring from the plastic transparent cover previously described [ 8 ].…”

Section: Discussionmentioning

confidence: 93%

“…Similar barrier techniques were already proposed and successfully used in other airway procedures during the COVID era, highlighting the fact that ENT surgeons have appreciated the importance of aerosol mitigation during ENT procedures [ 8 – 10 ]. Our method allowed for unrestricted hand movements and there was not any interference in the visualisation of the surgical field e.g., glaring from the plastic transparent cover previously described [ 8 ]. Contrary to the covers with open slits or ports, our tight-seal arrangement around the cables and incorporating the surgeon’s arms within the drape ensures minimal aerosol escape [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 93%

“…Our method allowed for unrestricted hand movements and there was not any interference in the visualisation of the surgical field e.g., glaring from the plastic transparent cover previously described [ 8 ]. Contrary to the covers with open slits or ports, our tight-seal arrangement around the cables and incorporating the surgeon’s arms within the drape ensures minimal aerosol escape [ 8 – 10 ].…”

Section: Discussionmentioning

confidence: 99%

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The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

Tsagkovits

Ioannidis

Rokade

2020

Eur Arch Otorhinolaryngol

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Background Otolaryngologists are faced with concerning challenges since the onset of the coronavirus disease (COVID-19) pandemic due to significant risk of occupational infection. Transmission can happen during intraoperative exposure to viral particles carried by droplets or aerosols. Endoscopic sinus and skull base surgery are notable for causing aerosolisation, putting healthcare staff at substantial risk. Method We describe the creation of a tight-seal tent from a microscope drape covering the operative field and the operator’s hands with the aim to contain aerosols during transnasal endoscopic surgery. Conclusion The microscope drape technique is a simple barrier measure that could potentially improve safety during endoscopic procedures.

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Otolaryngology–Head and Neck Surgery and COVID-19

Piccirillo

2020

JAMA

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The novel coronavirus disease 2019 (COVID-19) pandemic has had a particularly large influence on the specialty of otolaryngology-head and neck surgery. Molecularstudiesimplicatenasalepithelialcells,specificallygoblet and ciliated cells, as the entry site for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and a reservoir for dissemination within a given patient and from person to person. The development of acute loss of smell and taste was quickly recognized as one of the symptoms of COVID-19. 1 Thus, otolaryngologists were placed in the front line of management and risk exposure for COVID-19. Now, reports of various acute and chronic neuropathies in patients with COVID-19 disease support the continued involvement by otolaryngologists. As specialists of the upper airway, otolaryngologists are particularly vulnerable to transmission of SARS-CoV-2 through aerosol-generating procedures as part of their usual work in the ear, nose, and throat areas. 2 Along with colleagues in emergency medicine, intensive care medicine, and anesthesiology, otolaryngologists experience high rates of exposure and complications, including death due to COVID-19. 3 As a result, the practice of otolaryngology has changed substantially in response to COVID-19. The number of surgical procedures performed has decreased significantly.

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Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy

Abstract: We want to thank Martin Kauke, MD, for his invaluable contribution to this project. There was no financial compensation for this contribution.

Cited by 39 publications

References 6 publications

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

Otolaryngology–Head and Neck Surgery and COVID-19

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