Aslıhan GÜRÜN KAYA, Aydın ÇİLEDAĞ, Akın KAYA, Miraç ÖZ, Serhat EROL, İncifer KARNAK ORHUN, Demet KARNAK

A new device for bronchoscopy for better protection

Background/aim: During the COVID-19 pandemic, the risk of transmission of SARS-CoV-2 has not been precisely known in bronchoscopy procedures. We have designed a cabinet device called Ankara University Bronchoscopy Cabinet (Aubrocab® ) to protect healthcare. We aimed to evaluate preventing effect of Aubrocab® on aerosol spreading by measuring the particles in the bronchoscopy suite. Materials and methods: The patients were categorized into two groups as those who underwent bronchoscopy with and without Aubrocab® . We measured PM 0.5 levels before and after bronchoscopy in the bronchoscopy suite. Results: A total of 82 patients, 62 of whom underwent bronchoscopy with Aubrocab® , were enrolled in the study. The PM 0.5 level measured before bronchoscopy was similar in both groups, whereas the PM 0.5 level measured after bronchoscopy was lower in the Aubrocab® group (42,603 ± 8,632 vs. 50,377 ± 10,487, p = 0.001). The percent of particle change (50.76 ± 19.91 vs 67.15 ± 24.24, p = 0.003) and the difference of the particle numbers between pre and postprocedure (13,638 ± 4,292 and 19,501 ± 5,891, p < 0.001) were lower in the Aubrocab® group. Conclusion: Our institution developed a barrier device named Aubrocab® which was shown to prevent excessive aerosol release in addition to routine precautions during bronchoscopy procedures.

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1 Wahidi MM, Shojaee S, Lamb CR, Ost D, Maldonado F et al. The Use of Bronchoscopy During the Coronavirus Disease 2019 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. Chest 2020; 158 (3):1268-1281. doi: 10.1016/j. chest.2020.04.036
2 Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology 2020; 25 (6): 574-577. doi: 10.1111/resp.13824
3 Pritchett MA, Oberg CL, Belanger A, De Cardenas J, Cheng G et al. Society for Advanced Bronchoscopy Consensus Statement and Guidelines for bronchoscopy and airway management amid the COVID-19 pandemic. Journal of Thoracic Disease 2020; 12 (5): 1781-1798. doi: 10.21037/jtd.2020.04.32
4 Guedes F, Boleo-Tome JP, Rodrigues LV, Bastos HN, Campainha S et al. Recommendations for interventional pulmonology during COVID-19 outbreak: a consensus statement from the Portuguese Pulmonology Society. Pulmonology 2020; 26 (6): 386-397. doi: 10.1016/j.pulmoe.2020.07.007
5 Fang PH, Lin YY, Lin CH. A Protection Tent for Airway Management in Patients With COVID-19 Infection. Annals of Emergency Medicine 2020; 75 (6): 787-788. doi: 10.1016/j. annemergmed.2020.04.004
6 Laack TA, Pollok F, Sandefur BJ, Mullan AF, Russi CS et al. Barrier Enclosure for Endotracheal Intubation in a Simulated COVID-19 Scenario: A Crossover Study. The Western Journal of Emergency Medicine 2020; 21(5):1080-1083. doi: 10.5811/ westjem.2020.7.48574
7 Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier Enclosure during Endotracheal Intubation. The New England Journal of Medicine 2020; 382 (20):1957-1958. doi: 10.1056/NEJMc2007589
8 Clarke S. Physical defenses; in Brewis RA, Gibson GJ, Geddes DM, Gibson GJ (eds). Respiratory medicine. London: Saunders1990, pp 179-191.
9 Pomata D, Di Filippo P, Riccardi C, Castellani F, Simonetti G et al. Toxic Organic Contaminants in Airborne Particles: Levels, Potential Sources and Risk Assessment. International Journal of Environmental Research and Public Health 2021; 18 (8): 4352 doi: 10.3390/ijerph18084352
10 Sameer A A, Sweta Raja C. Bronchoscopy safety box and its utility as a barrier in spread of COVID-19 infection. Indian Journal of Respiratory Care 2021; 10 (1): 76-81. doi: 10.4103/ ijrc.ijrc_102_20
11 Tom R, Thomas J G. Protective Bronchoscopy Tent for the Pandemic Proceduralist. International Journal of Respiratory and Pulmonary Medicine 2020; 7: 139. doi: 10.23937/2378- 3516/1410139
12 Sorbello M, Rosenblatt W, Hofmeyr R, Greif R, Urdaneta F. Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis. British Journal of Anaesthesia 2020; 125 (6): 880- 894. doi: 10.1016/j.bja.2020.08.038
13 Nilson J, Bugaev N, Sekhar P, Hojman H, Gonzalez-Ciccarelli L et al. Portable negative pressure environment to protect staff during aerosol-generating procedures in patients with COVID-19. BMJ Open Respiratory Research 2020; 7 (1): e000653 doi: 10.1136/bmjresp-2020-000653
14 Begley JL, Lavery KE, Nickson CP, Brewster DJ. The aerosol box for intubation in coronavirus disease 2019 patients: an insitu simulation crossover study. Anaesthesia 2020; 75 (8): 1014- 1021. doi: 10.1111/anae.15115
15 Kloka JA, Martin C, Gilla P, Lotz G, Zacharowski K et al. Visualized effect of the Frankfurt COVid aErosol pRotEction Dome - COVERED. Indian Journal of Anaesthesia 2020; 64 (Suppl 2): S156-S158. doi: 10.4103/ija.IJA_569_20
16 Doggett N, Chow CW, Mubareka S. Characterization of Experimental and Clinical Bioaerosol Generation During Potential Aerosol-Generating Procedures. Chest 2020; 158 (6): 2467-2473. doi: 10.1016/j.chest.2020.07.026
17 Fishler R, Hofemeier P, Etzion Y, Dubowski Y, Sznitman J. Particle dynamics and deposition in true-scale pulmonary acinar models. Scientific Reports 2015; 5: 14071 doi: 10.1038/ srep14071
18 Hussain M, Pierre M. Lung deposition predictions of airborne particles and the emergence of contemporary diseases Part-I. theHealth 2011; 2: 51-59
19 Scheuch G: Breathing Is Enough. For the Spread of Influenza Virus and SARS-CoV-2 by Breathing Only. Journal of Aerosol Medicine and Pulmonary Drug Delivery 2020; 33 (4): 230-234. doi: 10.1089/jamp.2020.1616
20 Guzman MI. An overview of the effect of bioaerosol size in coronavirus disease 2019 transmission. International Journal of Health Planning and Management 2021; 36 (2): 257-266. doi: 10.1002/hpm.3095
21 Liu Y, Ning Z, Chen Y, Guo M, Liu Y et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature 2020; 582 (7813): 557-560. doi: 10.1038/s41586-020-2271-3
22 Lednicky JA, Lauzardo M, Alam MM, Elbadry MA, Stephenson CJ et al. Isolation of SARS-CoV-2 from the air in a car driven by a COVID patient with mild illness. International Journal of Infectious Diseases 202; 108: 212-216. doi: 10.1016/j. ijid.2021.04.063
23 Hersen G, Moularat S, Robine E, Gehin E, Corbet S et al. Impact of Health on Particle Size of Exhaled Respiratory Aerosols: Case-control Study. Clean (Weinh) 2008; 36 (7): 572- 577. doi: 10.1002/clen.200700189
24 Fabian P, McDevitt JJ, DeHaan WH, Fung RO, Cowling BJ et al. Influenza virus in human exhaled breath: an observational study. PLoS One 2008; 3 (7): e2691. doi: 10.1371/journal. pone.0002691
25 Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathogens 2013; 9 (3): e1003205. doi: 10.1371/journal.ppat.1003205
26 Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine 2020; 26 (5): 676-680. doi: 10.1038/s41591-020-0843-2
27 Angela L L, Kendrick M S, Rodrigo L, Jingping W. Effectiveness of a negative-pressure patient isolation hood shown using particle count. British Journal of Anaesthesia 2020; 125 (3): e295-e296. doi: 10.1016/j.bja.2020.05.002
28 Francom CR, Javia LR, Wolter NE, Lee GS, Wine T et al. Pediatric laryngoscopy and bronchoscopy during the COVID-19 pandemic: A four-center collaborative protocol to improve safety with perioperative management strategies and creation of a surgical tent with disposable drapes. International Journal of Pediatric Otorhinolaryngology 2020; 134:110059. doi: 10.1016/j.ijporl.2020.110059
29 Saito T, Asai T. Aerosol containment device for airway management of patients with COVID-19: a narrative review. Journal of Anesthesia 2021; 35 (3): 384-389. doi: 10.1007/ s00540-020-02879-4