key: cord-0896789-a67nydio
authors: Fusco, Pierfrancesco; Petroni, Gian Marco; Di Carlo, Stefano; Tullj, Stefania; Arcangeli, Valentina; Marinangeli, Franco
title: Use of a Modified System for Manual Ventilation of the Patient for In-Hospital and Extra-Hospital Transport to Avoid Aerosolizing Spread of Droplets During COVID-19 Outbreak
date: 2020-05-04
journal: Anesth Analg
DOI: 10.1213/ane.0000000000004922
sha: 8a2d7bf424a61e90dbdb6444377728c7f1bf7e3b
doc_id: 896789
cord_uid: a67nydio

nan

suggests that hospitals become a major source of COVID-19 carriers as they are populated by infected patients who transmit the virus to uninfected patients and health care workers when medication, mechanical ventilators, and personal protective equipment are not available. Asymptomatic or presymptomatic health care workers also become vectors.

We report our experience and illustrate our idea that has allowed us to create, using the available material, a safety device aimed at minimizing the spread of droplets for in-hospital and extra-hospital transfers of COVID-19 patients. On March 31, a patient with COVID-19 and intestinal ischemia presented to the San Salvatore Academy Hospital, L'Aquila, Italy. After surgery, he was transferred to the COVID Intensive Care Unit located in a pavilion outside the hospital. The problem arose from the lack of a portable ventilator. During the transfer, we provided manual ventilation using the DAR reservoir bag (Medtronic, Minneapolis, MN). We added a high-efficiency particulate air filter but felt it was more effective to place the filter on the expiratory exit of the DAR reservoir bag and not between the latter and the endotracheal tube as was described by Liew et al. 3 We used a filter called "DAR Adult Electrostatic Filter" that provided antibacterial and antiviral filtering ≥99,999%. 4 In this way, we were able to position a surgical mask on the filter, which deterred a possible spread of droplets and was psychologically more comfortable to the health care worker by minimizing his contact with the flow of air leaving the reservoir bag (Figure) . We feel that the presence of the surgical mask over the filter Use of a Modified System for Manual Ventilation of the Patient for In-Hospital and Extra-Hospital Transport to Avoid Aerosolizing Spread of Droplets During COVID-19 Outbreak Figure. DAR reservoir bag, with DAR filter at the expiratory exit of the bag, on which the surgical mask is placed. A and B, *Filter on the expiratory exit of the DAR reservoir bag. ○Surgical mask fixed on the filter with hemmed bandage.

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We thank health care personnel, the nurses, nurse aides, technicians, and environmental services of the San Salvatore Hospital L'Aquila Italy.