key: cord-0712358-kdcu6iy8
authors: Kusano, Chika; Goddard, James; Gotoda, Takuji
title: Experience for use of modified full‐face snorkel mask as personal protective equipment during endoscopic procedures in the era of coronavirus disease pandemic
date: 2020-06-27
journal: Dig Endosc
DOI: 10.1111/den.13784
sha: ff21ad0cc1fcafa917b5b78f5dc9f508bc5e8f7f
doc_id: 712358
cord_uid: kdcu6iy8

The rapid spread of COVID‐19 has led to personal protective equipment (PPE) shortage worldwide(1,2). Recently, the adaptation of commercially available modified full‐faced snorkel masks (mFFSMs) has been proposed as an alternative of PPE shortage. mFFSMs were adapted and used by health care workers during the COVID‐19 crisis(3). An mFFSM is composed of an off‐the‐shelf snorkel mask, a custom adapter (three‐dimensional‐printed with a custom print file that sourced attributes from the designs found at Pneumask and OceanReef.), and a filter cartridge (Figure1‐a).

This article is protected by copyright. All rights reserved

The rapid spread of COVID-19 has led to personal protective equipment (PPE) shortage worldwide 1, 2 . Recently, the adaptation of commercially available modified full-faced snorkel masks (mFFSMs) has been proposed as an alternative of PPE shortage. mFFSMs were adapted and used by health care workers during the COVID-19 crisis 3 . An mFFSM is composed of an off-the-shelf snorkel mask, a custom adapter (three-dimensional-printed with a custom print file that sourced attributes from the designs found at Pneumask and OceanReef.), and a filter cartridge

Nine endoscopists performed endoscopic procedures using general facial protection (N95 mask, goggle, and face shield) (Figure1-b) and mFFSM (Figure1-c). The vital signs of the endoscopists were assessed before they wore the PPE and were re-assessed after 30 minutes. All vital signs preand post-endoscopic procedures are shown in Table 1 . With a mFFSM, the respiratory rate increased significantly post-endoscopy (P=0.034). This is the first report of experience with using a mFFSM during endoscopic procedure. We estimated that the benefits of a snorkel mask are that it provided an integrated full-face shield instead of masks, goggles, and shields and allowed a clear view; thus, this mask is an off -label application. We can consider the use of mFFSM, when no alternative PPE is available.

The fit-test of the mFFSM has been reported 4 5 . The quantitative fit-test measures the leaks at the wearer's face, leaks concerning the connection after the filter, and leaks related to the exhaust valve. However, it was suggested that the rise in carbon dioxide (CO2) intake triggered an increase in minute ventilation and the respiratory rate, thereby maintaining the level of end-tidal CO2 within the normal range 4 . The mFFSM has the potential for use during endoscopic procedures when PPE is insufficient, it is necessary to consider the characteristics of mFFSMs concerning the possibility of CO2 accumulation.

Personal protective equipment during the COVID-19 pandemic -A narrative review

Critical supply shortages -The need for ventilators and personal protective equipment during the Covid-19 pandemic

This article is protected by copyright. All rights reserved