Aerosol Barrier Hood for Use in the Management of Critically Ill Adults With COVID-19.

To the Editor:

There has been significant discussion about the management of critically ill patients with coronavirus disease 2019 (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 and bilevel positive airway pressure, high-flow oxygen therapy, nebulized medications, and preoxygenation for intubation. Although fully enclosed NIPPV hoods are commercially available, they have not been widely used in the United States.

We acknowledge that the evidence for airborne transmission of COVID-19 is being actively debated and the extent of aerosolization by NIPPV is unclear. , The World Health Organization considers NIPPV an aerosol-generating procedure. A noteworthy difference between intubation and NIPPV is the duration of potential exposure and the number of health care workers at risk. 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 frontline health care workers caring for the high volume of patients with acute respiratory failure associated with COVID-19.

The hood is designed with half-inch polyvinyl chloride pipe, commonly available polyvinyl chloride fittings, 1×60-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 personal protective equipment. There has been strong support from nursing and ancillary staff members.

Figure 1

Aerosol hood design and proper application.

Figure 2

Clinical application of aerosol hood while performing bedside ultrasound.