key: cord-0792458-0wdvilhp
authors: Martel, Marc L.; Reardon, Robert F.
title: Aerosol Barrier Hood for Use in the Management of Critically Ill Adults With COVID-19
date: 2020-04-22
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2020.04.030
sha: b3d9874bf5d280d25c941ca436edea40a9dee3ec
doc_id: 792458
cord_uid: 0wdvilhp

nan

To the Editor, There has been significant discussion about the management of critically ill patients COVID-19.

We share concerns with many of our colleagues about the potential for airborne spread of the virus with common respiratory support procedures. Potentially high-risk procedures include noninvasive positive pressure ventilation (NIPPV), both continuous positive airway pressure (CPAP) as well as bilevel positive airway pressure (BiPAP), high-flow oxygen therapy, nebulized medications and pre-oxygenation for endotracheal intubation. 1 Although fully enclosed NIPPV hoods are commercially available they have not been widely used in the United States.

We acknowledge the fact that the evidence for airborne transmission of COVID-19 is being actively debated and the extent of aerosolization via NIPPV is unclear. 2,3 The World Health Organization considers NIPPV an aerosol generating procedure. 4 A noteworthy difference between endotracheal intubation and NIPPV is the duration of potential exposure and the number of healthcare workers at risk. Endotracheal intubation is generally performed in minutes with the intubating clinician at highest risk. NIPPV may be needed for hours and potentially days, with physicians, nurses, respiratory therapists and other staff at risk throughout.

To combat this exposure, we have designed a simple hood that may reduce the spread of aerosols during these high-risk procedures, particularly NIPPV. The hood is made from readily available components that may be purchased at home improvement stores. The goal of the device is to provide an additional layer of personal protection for front-line healthcare workers caring for the high volume of patients with acute respiratory failure associated with COVID-19.

The hood is designed using ½ inch polyvinyl chloride (PVC) pipe, commonly available PVC fittings, 1 x 60 inch straps with buckles, and 95-gallon clear plastic bags (Figure 1) . Experience with the "aerosol barrier hood" in our emergency department has suggested that the hood is well tolerated by patients requiring NIPPV and nebulized medications. Additionally, the large plastic enclosure allows easy access to the patient for routine care during these procedures (Figure 2 ). Our anecdotal experience, although positive, has not been validated and the hood should be considered an adjunct to standard PPE. There has been strong support from nursing and ancillary staff members.

Management of critically ill adults with COVID-19

Clinical management of pandemic 2009 influenza A (H1N1) infection

Transmission potential of SARS-Co-V-2 in viral shedding observed at the university of Nebraska medical center

Infection prevention and control of epidemic-and pandemic-prone acute respirator infections in health care. WHO guidelines