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Imran Ahmad - One of the best experts on this subject based on the ideXlab platform.
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influence of Respiratory protective equipment on simulated advanced airway skills by specialist tracheal intubation teams during the covid 19 pandemic
Trends in Anaesthesia and Critical Care, 2021Co-Authors: J Schumacher, Clarissa Carvalho, Paul Greig, Sophie Ragbourne, Imran AhmadAbstract:Abstract Background The COVID-19 pandemic has highlighted the importance of Respiratory protective equipment for clinicians performing airway management. Aim To evaluate the impact of powered air-purifying Respirators, full-face air-purifying Respirators and filtering facepieces on specially trained anaesthesiologists performing difficult airway procedures. Methods All our COVID-19 intubation team members carried out various difficult intubation drills: unprotected, wearing a full-face Respirator, a filtering facepiece or a powered Respirator. Airway management times and wearer comfort were evaluated and analysed. Results Total mean (SD) intubation times did not show significant differences between the control, the powered, the full-face Respirator and the filtering facepiece groups: Airtraq 6.1 (4.4) vs. 5.4 (3.1) vs. 6.1 (5.6) vs. 7.7 (7.6) s; videolaryngoscopy 11.4 (9.0) vs. 7.7 (4.3) vs. 9.8 (8.4) vs. 12.7 (9.8) s; fibreoptic intubation 16.6 (7.8) vs.13.8 (6.7) vs. 13.6 (8.1) vs. 16.9 (9.2) s; and standard endotracheal intubation by direct laryngoscopy 8.1 (3.5) vs. 6.5 (5.6) vs. 6.2 (4.2) vs. 8.0 (4.4) s, respectively. Use of the Airtraq achieved the shortest intubation times. Anaesthesiologists rated temperature and vision significantly better in the powered Respirator group. Conclusions Advanced airway management remains unaffected by the Respiratory protective equipment used if performed by a specially trained, designated team. We conclude that when advanced airway skills are performed by a designated, specially trained team, airway management times remain unaffected by the Respiratory protective equipment used.
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the impact of Respiratory protective equipment on difficult airway management a randomised crossover simulation study
Anaesthesia, 2020Co-Authors: J Schumacher, D Dudley, M Sicinski, James Arlidge, Imran AhmadAbstract:The current international COVID-19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air-purifying Respirators and powered air-purifying Respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered Respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard Respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq™; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the Respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered Respirator group; however, noise levels were perceived to be significantly lower than in the standard Respirator group. We conclude that standard and powered Respirators do not significantly prolong simulated advanced intubation procedures.
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the impact of Respiratory protective equipment on difficult airway management a randomised crossover simulation study
Anaesthesia, 2020Co-Authors: J Schumacher, D Dudley, M Sicinski, James Arlidge, Imran AhmadAbstract:Summary The current international coronavirus disease 19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air purifying Respirators and powered air purifying Respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard, or a powered Respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision, and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard Respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq?, 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope, 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope, and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard endotracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy achieved the shortest intubation times regardless of the Respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered Respirator group; however, noise levels were perceived to be significantly lower than in the standard Respirator group. We conclude that standard and powered Respirators do not significantly prolong simulated advanced intubation procedures.
Lewis J. Radonovich - One of the best experts on this subject based on the ideXlab platform.
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n95 Respirators vs medical masks for preventing influenza among health care personnel a randomized clinical trial
JAMA, 2019Co-Authors: Lewis J. Radonovich, Michael S Simberkoff, Mary T Essese, Derek A T Cummings, Charlotte A Gaydos, Jenna Los, Amanda Krosche, Cynthia L GibeAbstract:Importance Clinical studies have been inconclusive about the effectiveness of N95 Respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral Respiratory infections. Objective To compare the effect of N95 Respirators vs medical masks for prevention of influenza and other viral Respiratory infections among HCP. Design, Setting, and Participants A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral Respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 Respirator or medical mask groups. Interventions Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 Respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with Respiratory illness. Main Outcomes and Measures The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute Respiratory illness, laboratory-detected Respiratory infections, laboratory-confirmed Respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 Respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, −0.5% to 2.5%];P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute Respiratory illness events in the Respirator group vs 1711 in the mask group (difference, −21.9 per 1000 HCP-seasons [95% CI, −48.2 to 4.4];P = .10); 679 laboratory-detected Respiratory infections in the Respirator group vs 745 in the mask group (difference, −8.9 per 1000 HCP-seasons, [95% CI, −33.3 to 15.4];P = .47); 371 laboratory-confirmed Respiratory illness events in the Respirator group vs 417 in the mask group (difference, −8.6 per 1000 HCP-seasons [95% CI, −28.2 to 10.9];P = .39); and 128 influenzalike illness events in the Respirator group vs 166 in the mask group (difference, −11.3 per 1000 HCP-seasons [95% CI, −23.8 to 1.3];P = .08). In the Respirator group, 89.4% of participants reported “always” or “sometimes” wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance Among outpatient health care personnel, N95 Respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration ClinicalTrials.gov Identifier:NCT01249625
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B95: A new Respirator for health care personnel
American journal of infection control, 2013Co-Authors: Megan Gosch, Ronald E. Shaffer, Raymond J. Roberge, Aaron Eagan, Victoria J. Davey, Lewis J. RadonovichAbstract:Background Respiratory protection relies heavily on user compliance to be effective, but compliance among health care personnel is less than ideal. Methods In 2008, the Department of Veterans Affairs formed the Project Better Respiratory Equipment using Advanced Technologies for Healthcare Employees (BREATHE) Working Group, composed of a variety of federal stakeholders, to discuss strategies for improving Respirator compliance, including the need for more comfortable Respirators. Results The Working Group developed 28 desirable performance characteristics that can be grouped into 4 key themes: (1) Respirators should perform their intended function safely and effectively; (2) Respirators should support, not interfere, with occupational activities; (3) Respirators should be comfortable and tolerable for the duration of wear; and (4) Respiratory protective programs should comply with federal/state standards and guidelines and local policies. As a necessary next step, the Working Group identified the need for a new class of Respirators, to be called “B95,” which would better address the unique needs of health care personnel. Conclusion This article summarizes the outputs of the Project BREATHE Working Group and provides a national strategy to develop clinically validated Respirator test methods, to promulgate B95 Respirator standards, and to invent novel design features, which together will lead to commercialized B95 Respirators.
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discomfort and exertion associated with prolonged wear of Respiratory protection in a health care setting
Journal of Occupational and Environmental Hygiene, 2012Co-Authors: Brian V Shenal, Lewis J. Radonovich, Jing Cheng, Michael J Hodgson, Bradley S BenderAbstract:The nature of discomfort and level of exertion associated with wearing Respiratory protection in the health care workplace are not well understood. Although a few studies have assessed these topics in a laboratory setting, little is known about the magnitude of discomfort and the level of exertion experienced by workers while they deliver health care to patients for prolonged periods. The purpose of this study was to determine the magnitude of discomfort and level of exertion experienced by health care workers while wearing Respiratory protection for periods up to 8 hr when performing their typical occupational duties. This project was a multiple cross-over field trial of 27 health care workers, aged 24-65, performing their typical, hospital-based occupational duties. Each participant served as his/her own control and wore one of seven Respirators or a medical mask for 8 hr (or as long as tolerable) with interposed doffing periods every 2 hr. Self-perceived discomfort and exertion were quantified before each doffing: self-perceived level of discomfort using a visual analog scale, and self-perceived level of exertion using a Borg scale. Overall, and as would be expected, discomfort increased over time with continual Respirator use over an 8-hr period. Interestingly, exertion increased only marginally over the same time period. The relatively low level of exertion associated with eight Respiratory protective devices, including models commonly used in the U.S. health care workplace, is not likely to substantially influence workers' tolerability or occupational productivity. However, the magnitude of discomfort does appear to increase significantly over time with prolonged wear. These results suggest that Respirator-related discomfort, but not exertion, negatively influences Respirator tolerance over prolonged periods. Discomfort may also interfere with the occupational duties of workers.
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health care workers views about Respirator use and features that should be included in the next generation of Respirators
American Journal of Infection Control, 2010Co-Authors: Aliya S Baig, Aaron Eagan, Caprice Knapp, Lewis J. RadonovichAbstract:Background Numerous studies have demonstrated that health care workers are, in general, poorly compliant with Respiratory protection guidelines, especially when a N95 Respirator is recommended. The purpose of this study was to assess health care workers' views about Respirator use and the features they prefer to be included in the next generation of Respirators. Methods A 63-item survey was distributed to health care workers in 27 units of 2 tertiary care medical centers. Results From a total of 559 surveys distributed at both hospitals, 159 responses were returned (response rate, 28%). Survey results indicated that health care workers seek Respirators that are more comfortable, interfere less with breathing, diminish heat buildup, are disposable, and permit the user to have facial hair. Multivariate analyses suggest that emergency department staff had 12.3 greater odds of wanting a new Respirator ( P = .031) as compared with their referent group. Males were more likely to indicate that the N95 Respirator was comfortable to wear versus females ( P = .003). Conclusion To increase substantially the acceptance of Respiratory protective equipment and improve compliance rates, Respirators should be modified to meet the specific needs of health care workers.
J Schumacher - One of the best experts on this subject based on the ideXlab platform.
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influence of Respiratory protective equipment on simulated advanced airway skills by specialist tracheal intubation teams during the covid 19 pandemic
Trends in Anaesthesia and Critical Care, 2021Co-Authors: J Schumacher, Clarissa Carvalho, Paul Greig, Sophie Ragbourne, Imran AhmadAbstract:Abstract Background The COVID-19 pandemic has highlighted the importance of Respiratory protective equipment for clinicians performing airway management. Aim To evaluate the impact of powered air-purifying Respirators, full-face air-purifying Respirators and filtering facepieces on specially trained anaesthesiologists performing difficult airway procedures. Methods All our COVID-19 intubation team members carried out various difficult intubation drills: unprotected, wearing a full-face Respirator, a filtering facepiece or a powered Respirator. Airway management times and wearer comfort were evaluated and analysed. Results Total mean (SD) intubation times did not show significant differences between the control, the powered, the full-face Respirator and the filtering facepiece groups: Airtraq 6.1 (4.4) vs. 5.4 (3.1) vs. 6.1 (5.6) vs. 7.7 (7.6) s; videolaryngoscopy 11.4 (9.0) vs. 7.7 (4.3) vs. 9.8 (8.4) vs. 12.7 (9.8) s; fibreoptic intubation 16.6 (7.8) vs.13.8 (6.7) vs. 13.6 (8.1) vs. 16.9 (9.2) s; and standard endotracheal intubation by direct laryngoscopy 8.1 (3.5) vs. 6.5 (5.6) vs. 6.2 (4.2) vs. 8.0 (4.4) s, respectively. Use of the Airtraq achieved the shortest intubation times. Anaesthesiologists rated temperature and vision significantly better in the powered Respirator group. Conclusions Advanced airway management remains unaffected by the Respiratory protective equipment used if performed by a specially trained, designated team. We conclude that when advanced airway skills are performed by a designated, specially trained team, airway management times remain unaffected by the Respiratory protective equipment used.
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the impact of Respiratory protective equipment on difficult airway management a randomised crossover simulation study
Anaesthesia, 2020Co-Authors: J Schumacher, D Dudley, M Sicinski, James Arlidge, Imran AhmadAbstract:The current international COVID-19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air-purifying Respirators and powered air-purifying Respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard or a powered Respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard Respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq™; 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope; 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope; and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard tracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy allowed the shortest intubation times regardless of the Respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered Respirator group; however, noise levels were perceived to be significantly lower than in the standard Respirator group. We conclude that standard and powered Respirators do not significantly prolong simulated advanced intubation procedures.
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the impact of Respiratory protective equipment on difficult airway management a randomised crossover simulation study
Anaesthesia, 2020Co-Authors: J Schumacher, D Dudley, M Sicinski, James Arlidge, Imran AhmadAbstract:Summary The current international coronavirus disease 19 health crisis underlines the importance of adequate and suitable personal protective equipment for clinical staff during acute airway management. This study compares the impacts of standard air purifying Respirators and powered air purifying Respirators during simulated difficult airway scenarios. Twenty-five anaesthetists carried out four different standardised difficult intubation drills, either unprotected (control), or wearing a standard, or a powered Respirator. Treatment times and wearer comfort were determined and compared. In the wearer comfort evaluation form, operators rated mobility, noise, heat, vision, and speech intelligibility. All anaesthetists accomplished the treatment objectives of all study arms without adverse events. Total mean (SD) intubation times for the four interventions did not show significant differences between the powered and the standard Respirator groups, being 16.4 (8.6) vs. 19.2 (5.2) seconds with the Airtraq?, 11.4 (3.4) vs. 10.0 (2.1) seconds with the videolaryngoscope, 39.2 (4.5) vs. 40.1 (4.8) seconds with the fibreoptic bronchoscope scope, and 15.4 (5.7) vs. 15.1 (5.0) seconds for standard endotracheal intubation by direct laryngoscopy, respectively. Videolaryngoscopy achieved the shortest intubation times regardless of the Respiratory protective device used. Anaesthetists rated heat and vision significantly higher in the powered Respirator group; however, noise levels were perceived to be significantly lower than in the standard Respirator group. We conclude that standard and powered Respirators do not significantly prolong simulated advanced intubation procedures.
C R Macintyre - One of the best experts on this subject based on the ideXlab platform.
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availability consistency and evidence base of policies and guidelines on the use of mask and Respirator to protect hospital health care workers a global analysis
BMC Research Notes, 2013Co-Authors: Abrar Ahmad Chughtai, C R Macintyre, Holly SealeAbstract:Currently there is an ongoing debate and limited evidence on the use of masks and Respirators for the prevention of Respiratory infections in health care workers (HCWs). This study aimed to examine available policies and guidelines around the use of masks and Respirators in HCWs and to describe areas of consistency between guidelines, as well as gaps in the recommendations, with reference to the WHO and the CDC guidelines. Policies and guidelines related to mask and Respirator use for the prevention of influenza, SARS and TB were examined. Guidelines from the World Health Organization (WHO), the Center for Disease Control and Prevention (CDC), three high-income countries and six low/middle-income countries were selected. Uniform recommendations are made by the WHO and the CDC in regards to protecting HCWs against seasonal influenza (a mask for low risk situations and a Respirator for high risk situations) and TB (use of a Respirator). However, for pandemic influenza and SARS, the WHO recommends mask use in low risk and Respirators in high risk situations, whereas, the CDC recommends Respirators in both low and high risk situations. Amongst the nine countries reviewed, there are variations in the recommendations for all three diseases. While, some countries align with the WHO recommendations, others align with those made by the CDC. The choice of Respirator and the level of filtering ability vary amongst the guidelines and the different diseases. Lastly, none of the policies discuss reuse, extended use or the use of cloth masks. Currently, there are significant variations in the policies and recommendations around mask and Respirator use for protection against influenza, SARS and TB. These differences may reflect the scarcity of level-one evidence available to inform policy development. The lack of any guidelines on the use of cloth masks, despite widespread use in many low and middle-income countries, remains a policy gap. Health organizations and countries should jointly evaluate the available evidence, prioritize research to inform evidence gaps, and develop consistent policy on masks and Respirator use in the health care setting.
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a cluster randomized clinical trial comparing fit tested and non fit tested n95 Respirators to medical masks to prevent Respiratory virus infection in health care workers
Influenza and Other Respiratory Viruses, 2011Co-Authors: C R Macintyre, Quanyi Wang, Simon Cauchemez, Holly Seale, Dominic E Dwyer, Peng Yang, Weixian Shi, Zhanhai Gao, Xinghuo Pang, Yi ZhangAbstract:Please cite this paper as: MacIntyre et al. (2011) A cluster randomized clinical trial comparing fit-tested and non-fit-tested N95 Respirators to medical masks to prevent Respiratory virus infection in health care workers. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2010.00198.x. Background We compared the efficacy of medical masks, N95 Respirators (fit tested and non fit tested), in health care workers (HCWs). Methods A cluster randomized clinical trial (RCT) of 1441 HCWs in 15 Beijing hospitals was performed during the 2008/2009 winter. Participants wore masks or Respirators during the entire work shift for 4 weeks. Outcomes included clinical Respiratory illness (CRI), influenza-like illness (ILI), laboratory-confirmed Respiratory virus infection and influenza. A convenience no-mask/Respirator group of 481 health workers from nine hospitals was compared. Findings The rates of CRI (3·9% versus 6·7%), ILI (0·3% versus 0·6%), laboratory-confirmed Respiratory virus (1·4% versus 2·6%) and influenza (0·3% versus 1%) infection were consistently lower for the N95 group compared to medical masks. By intention-to-treat analysis, when P values were adjusted for clustering, non-fit-tested N95 Respirators were significantly more protective than medical masks against CRI, but no other outcomes were significant. The rates of all outcomes were higher in the convenience no-mask group compared to the intervention arms. There was no significant difference in outcomes between the N95 arms with and without fit testing. Rates of fit test failure were low. In a post hoc analysis adjusted for potential confounders, N95 masks and hospital level were significant, but medical masks, vaccination, handwashing and high-risk procedures were not. Interpretation Rates of infection in the medical mask group were double that in the N95 group. A benefit of Respirators is suggested but would need to be confirmed by a larger trial, as this study may have been underpowered. The finding on fit testing is specific to the type of Respirator used in the study and cannot be generalized to other Respirators. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN: ACTRN12609000257268 (http://www.anzctr.org.au).
Yves Longtin - One of the best experts on this subject based on the ideXlab platform.
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impact of extended use and decontamination with vaporized hydrogen peroxide on n95 Respirator fit
American Journal of Infection Control, 2020Co-Authors: Anthony Lieu, Veronica Zanichelli, Rose Carmel Exantus, Yves LongtinAbstract:ABSTRACT Background To address the shortage of N95 Respirators in the wake of the COVID19 pandemic, some organizations have recommended the decontamination of Respirators using vaporized hydrogen peroxide (VHP) sterilizer for up to 10 times. However, these recommendations are based on studies that did not take into account the extended use of Respirators, which can degrade Respirator fit. Methods We investigated the impact of extended use and decontamination with VHP on N95 Respirator Fit. We performed a prospective cohort study to determine the number of times Respirators can be decontaminated before Respirator fit test failure. The primary outcome was the overall number of cycles required for half of the Respirators to fail (either mechanical failure or fit test failure). Results 36 participants completed 360 hours of Respirator usage across 90 cycles. The median number of cycles completed by participants before Respirator failure was 2. The overall number of cycles required for half of Respirators to fail was 1, 3, 5 and 4 for the 3M 1860(S), 3M 1870+, Moldex 151X and ProGear 88020 Respirators, respectively. Conclusion The combination of prolonged usage and VHP decontamination was associated with early failure. Decontamination and prolonged usage of Respirators must be done cautiously.
