A Rapidly Deployable Negative Pressure Enclosure for Aerosol-Generating Medical Procedures

Anthony M. Chahal; Kenneth Van Dewark; Robert Gooch; Erin Fukushima; Zachary M. Hudson

Many patients with COVID-19 present with respiratory distress and require immediate airway support. Intubation, bag-mask ventilation (BMV), and the provision of high-flow oxygen may cause aerosolization of viral particles, increasing the risk to healthcare providers. 1 During the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003, intubation was identified as an independent risk factor for physician illness. 1 Negative pressure rooms, minimizing bedside staff, and wearing appropriate PPE are all recommended to mitigate the risk to healthcare providers during AGMPs. Recommendations for intubation suggest limiting oxygen flows for preoxygenation, avoiding apneic oxygenation, and avoiding bag-mask ventilation. Modified procedures during intubation include the use of a plastic sheet to cover the patient, or the use of a solid plastic shield separating healthcare providers from the patient's airway. 2 The authors propose that a negative pressure enclosure over a patient during intubation could reduce the risk of virus transmission to the healthcare team during AGMPs. Building upon the open plastic shield first proposed by Dr. Hsien-Yung Lai, the authors developed a negative pressure micro-enclosure which limits outward aerosol transmission. 3 This enclosure can be assembled at limited cost and deployed rapidly during emergent airway management, with simple resources found in many emergency departments and critical care spaces. Post-procedure, the enclosure can be cleaned for immediate reuse.