The critically ill avian influenza A (H5N1) patient*

Arabi, Yaseen M.; Gomersall, Charles D.; Ahmed, Qanta A.; Boynton, Bruce R.; Memish, Ziad A.

doi:10.1097/01.ccm.0000262940.34596.4b

Cited by 45 publications

(55 citation statements)

References 61 publications

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“…An additional understanding of the limitations of all layers of protection (eg, accidental circuit disconnection, endotracheal dislodgement or cuff leak, improper use or fit of personal protective equipment, incomplete immunization, inadequate hand-washing) is essential to preventing infectious disease transmission; none of these strategies should be assumed fail-safe, and the addition of multiple layers of protection starting at the source, including use of filtration, may be employed as a comprehensive strategy to reduce infectious spread. 5,17 …”

Section: Discussionmentioning

confidence: 99%

“…3 Oscillation may be required when patients develop ARDS from potentially lethal and highly transmissible viruses such as novel influenza H1N1 (swine flu), influenza H5N1 (avian flu), or severe acute respiratory syndrome (SARS). 4,5 Occupational transmission to healthcare workers from patients with bacterial pneumonia has also been described during respiratory care procedures that occur at close proximity. 6 When using a high frequency oscillator, expiratory gas is vented out relief valves directly into the atmosphere.…”

Section: Introductionmentioning

confidence: 99%

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Modification of a High Frequency Oscillator Circuit With a Heated Expiratory Filter to Prevent Infectious Pathogen Transmission: A Bench Study

McKeown

Serreqi

2012

Respir Care

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BACKGROUND: High frequency oscillation is a safe and effective treatment for patients with ARDS, but poses a patient and caregiver risk when the circuit is disconnected. We modified the circuit to include a heated expiratory filter, eliminating the need for daily filter changes due to buildup of condensate. The purpose of the study was to determine if substitution of the filter resulted in a clinically important change in delivered tidal volume or amplitude. We additionally compared expiratory resistance and measured efficacy for the substituted filter. METHODS: This bench study measured tidal volume and amplitude using 5 of each filter type across 6 patient setting scenarios. Filter efficacy was tested through an independent laboratory, and expiratory resistance measurements were taken after prolonged use with humidification. RESULTS: The clinically important threshold value for tidal volume (defined as 5% difference) was excluded by the limits of agreement, confirming that use of the modified circuit does not result in alterations in tidal volume. The clinically important threshold for amplitude (defined as 10% difference) was the same as the lower confidence interval on the lower limit of agreement, indicating it is possible for amplitude values to be different between the 2 filters. Filter efficacy for the substituted filter was not affected. Expiratory resistance was unchanged in the substituted filter, but nearly doubled for the manufacturer's filter after 48 hours. CONCLUSIONS: Modifying the circuit to include a heated expiratory filter does not affect tidal volume, and the filter material remains efficacious during oscillation. Amplitude varies under some conditions. Preventing the need for daily filter changes reduces the risk of alveolar de-recruitment. This does not completely eliminate exposure to expired gases, but provides an additional layer of protection against occupational exposure and nosocomial spread of respiratory pathogens. Further testing in a clinical environment is necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modification of a High Frequency Oscillator Circuit With a Heated Expiratory Filter to Prevent Infectious Pathogen Transmission: A Bench Study

McKeown

Serreqi

2012

Respir Care

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“…18,19 Globally, the usual proportion of ICU beds providing paediatric care is much lower than this, and ICU staff not familiar with children may expect to be called on to manage paediatric cases. It may therefore be prudent for ICU staff usually treating only adult patients to acquire a basic knowledge of paediatric ICU principles.…”

Section: Expanding Icu Capacitymentioning

confidence: 99%

SARS, Bird Flu and other scares—epidemic and pandemic preparedness in intensive care

Joynt

Gomersall

2008

Southern African Journal of Anaesthesia and Analgesia

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“…56, 109–110, 112–114 Duty of care is neither a fixed nor absolute concept but is heavily dependent on context. Hospitals should inform prospective staff members of what is expected in crisis situations before, rather than in the midst of, an emergency”.…”

Section: Introductionmentioning

confidence: 99%

Pandemic Influenza

Manuell

Ellison

2011

J Intensive Care Med

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In a five week span during the 1918 influenza A pandemic, more than 2,000 patients were admitted to Cook County Hospital in Chicago with a diagnosis of either influenza or pneumonia; 642 patients, approximately 31% of those admitted, died with deaths occurring predominantly in patients twenty-five to thirty years of age.1 This review summarizes basic information on the biology, epidemiology, control, treatment and prevention of influenza overall, and then addresses the potential impact of pandemic influenza in an Intensive Care Unit setting. Issues that require consideration include workforce staffing and safety, resource management, alternate sites of care surge of patients, altered standards of care and crisis communication.

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The critically ill avian influenza A (H5N1) patient*

Cited by 45 publications

References 61 publications

Modification of a High Frequency Oscillator Circuit With a Heated Expiratory Filter to Prevent Infectious Pathogen Transmission: A Bench Study

Modification of a High Frequency Oscillator Circuit With a Heated Expiratory Filter to Prevent Infectious Pathogen Transmission: A Bench Study

SARS, Bird Flu and other scares—epidemic and pandemic preparedness in intensive care

Pandemic Influenza

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