Letter to the Editor
Oxygenation device with reservoir and PEEP (ODRPEEP) in patients with acute respiratory distress due to COVID-19
Dispositivo de oxigenación con reservorio y PEEP (DORPEEP) en pacientes con dificultad respiratoria aguda por COVID-19
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El volumen de inspiración necesario se realizará de la bolsa reservorio mientras que la espiración del paciente se realiza por la válvula PEEP con un filtro antibacteriano y vírico.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">B: En el caso de necesitar administrar fármacos inhalados usamos el aplique para cartucho presurizado, necesitando para su conexión un extremo de alargadera de O<span class="elsevierStyleInf">2</span> que engancharemos a presión en uno de los orificios de la mascarilla.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSmallCaps">C</span>: Podremos aplicar fármaco inhalado sin nebulización. Utilizaremos el esquema de la opción «a» añadiendo un aplique en T para cartucho presurizado entre el codo y la T del reservorio.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">D: Nos permitirá nebulizar disminuyendo el riesgo de aerosoles al exterior. Utilizaremos el esquema de la opción «a» añadiendo una pieza en T con un vaso de nebulización y alargadera. Sin nebulización aportaremos al reservorio un flujo de 15 L/min y durante la nebulización el flujo deberá ser repartido entre el reservorio y el vaso nebulizador para evitar hiperoxigenación.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Oscar Segura Alba, Antonio Nieto Fernández-Pacheco, Manuel Pardo Ríos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Oscar" "apellidos" => "Segura Alba" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Nieto Fernández-Pacheco" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Pardo Ríos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020620302862" "doi" => "10.1016/j.medcle.2020.04.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620302862?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320302608?idApp=UINPBA00004N" "url" => "/00257753/0000015500000003/v1_202008030608/S0025775320302608/v1_202008030608/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020620302898" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.05.003" "estado" => "S300" "fechaPublicacion" => "2020-08-14" "aid" => "5196" "copyright" => "Elsevier España, S.L.U." 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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "Manuel" "apellidos" => "Pardo Ríos" "email" => array:1 [ 0 => "mpardo@ucam.edu" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Universidad Católica de Murcia (UCAM), Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dispositivo de oxigenación con reservorio y PEEP (DORPEEP) en pacientes con dificultad respiratoria aguda por COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 494 "Ancho" => 1750 "Tamanyo" => 84948 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagram of the different options related to the oxygenation device with reservoir and PEEP (ODRPEEP).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A: It consists of an appropriately sized, one-piece "T-shaped" NIV mask with closed elbow connected to a reservoir bag with its 15 L/min oxygen connection, a filter for bacteria and viruses with a filtering efficiency of > 99.99 % and a PEEP valve. The necessary inspiration volume will be made from the reservoir bag while the patient's expiration is done through the PEEP valve with an antibacterial and viral filter.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">B: In the case of needing to administer inhaled drugs, we use the pressurized cartridge fitting, needing an O<span class="elsevierStyleInf">2</span> extension end for its connection which we will snap into one of the holes in the mask.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSmallCaps">C</span>: We can apply an inhaled drug without nebulization. We will use the diagram of option «a» adding a T-fitting for a pressurized cartridge between the elbow and the T of the reservoir bag.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">D: It will allow us to nebulize reducing the risk of aerosol leaks. We will use the diagram of option «a» adding a T-piece with a nebulization cup and extension. Without nebulization, we will provide the reservoir with a flow of 15 L/min and during nebulization, the flow must be distributed between the reservoir and the nebulizer cup to avoid hyperoxygenation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">On 11th March 2020, the World Health Organization (WHO) declared a global pandemic status due to the current outbreak of coronavirus disease (COVID-19), which was first reported in Wuhan (China) on 31 December 2019.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> At present, COVID-19 is severely impacting a large number of countries, including those that are supposed to be most resilient. In 2009, Castro et al. indicated the need to create a triage system to adapt our healthcare system to possible influenza pandemics.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This article written for Influenza A (H1N1) already showed the need to adapt protocols to the different phases of the pandemic, to avoid the spread of the virus, the saturation of healthcare centres with mild patients and the contamination of healthcare facilities with the virus, as well as reducing the morbidity and mortality of critically ill patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this same sense, with respect to COVID-19, the <span class="elsevierStyleItalic">Center for Disease Control and Prevention</span> (CDC), recommends decreasing and taking extreme caution with aerosol-generating procedures,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> such as: Ventilation with mask and self-inflating bag, aspiration of secretions, orotracheal intubation (OTI), application of nebulisations, use of non-invasive ventilation (NIV) and cardiopulmonary resuscitation (CPR) manoeuvres.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The results of the analysis of a cohort of COVID-19 patients throughout China have shown that 3.4% of infected patients presented with acute respiratory distress syndrome (ARDS), representing 40% of the total number of patients who showed severe pathologies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">ARDS causes exudate alveolar invasion in the lung and a decrease in lung compliance, generating mainly hypoxemic respiratory failure. In prehospital care, diagnosis is based on detecting an ineffective respiratory pattern with impaired ventilatory auscultation, a decrease in oxygen saturation, and an increase in respiratory rate.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In these patients, oxygenation with a reservoir mask will be a priority as the first step in the treatment of ARDS. In the second step, the use of non-invasive ventilation (NIV) will be considered as risk due to possible leaks that may appear,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> especially during ambulance transport, with invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO) being relegated to the last step of treatment. The administration of inhaled therapy must be strictly supervised to avoid external contamination.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">At the prehospital level, we are faced with the problem of how to ventilate patients who are inefficient in oxygenation by means of a mask with a reservoir bag. In this case, the next step would be the use of NIV, but we have the risk of external contamination. As it is a high-flow ventilation, its use is limited to hospital rooms with negative pressure.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this exceptional context that COVID-19 has generated, it is where we propose to assess the use of our device that, although we do not have randomized clinical trials (RCTs) that support its use, we think that it can be an alternative when there is no chance of performing mechanical ventilation, and especially for patients in whom the usual oxygen therapy techniques are not being effective enough, designed not to replace NIV but as an alternative in this context. With the 'oxygenation device with reservoir and PEEP' (ODRPEEP) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) we can oxygenate the patient with a reservoir bag in the inspiratory phase, and in the expiratory phase the inlet of the reservoir bag will be closed with the built-in valve and the exhalation will be done through a virus and bacteria-proof filter with a > 99.9% efficacy and a PEEP valve avoiding alveolar collapse thanks to a spring system. In addition, the device will allow us to safely apply inhaled drugs.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The inherent safety of this device is based on the fact that there is no external contamination thanks to the NIV mask, the low pressures inside and the exhalation through the filter. Even so, the authors recommend caution when applying and conducting RCTs that compare the results of ODRPEEP with NIV and determine if both options can be considered to have a certain therapeutic equivalence.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This article has not received any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-04" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Segura Alba O, Nieto Fernández-Pacheco A, Pardo Ríos M. Dispositivo de oxigenación con reservorio y PEEP (DORPEEP) en pacientes con dificultad respiratoria aguda por COVID-19. Med Clin (Barc). 2020;155:133–134.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 494 "Ancho" => 1750 "Tamanyo" => 84948 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diagram of the different options related to the oxygenation device with reservoir and PEEP (ODRPEEP).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A: It consists of an appropriately sized, one-piece "T-shaped" NIV mask with closed elbow connected to a reservoir bag with its 15 L/min oxygen connection, a filter for bacteria and viruses with a filtering efficiency of > 99.99 % and a PEEP valve. The necessary inspiration volume will be made from the reservoir bag while the patient's expiration is done through the PEEP valve with an antibacterial and viral filter.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">B: In the case of needing to administer inhaled drugs, we use the pressurized cartridge fitting, needing an O<span class="elsevierStyleInf">2</span> extension end for its connection which we will snap into one of the holes in the mask.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSmallCaps">C</span>: We can apply an inhaled drug without nebulization. We will use the diagram of option «a» adding a T-fitting for a pressurized cartridge between the elbow and the T of the reservoir bag.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">D: It will allow us to nebulize reducing the risk of aerosol leaks. We will use the diagram of option «a» adding a T-piece with a nebulization cup and extension. Without nebulization, we will provide the reservoir with a flow of 15 L/min and during nebulization, the flow must be distributed between the reservoir and the nebulizer cup to avoid hyperoxygenation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brote de enfermedad por coronavirus (COVID-19). Accessed 28 Mar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Organización Mundial de la Salud (OMS)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sistema sanitario y triaje ante una pandemia de gripe: un enfoque desde la salud pública" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Castro Delgado" 1 => "P. Arcos González" 2 => "A. Rodríguez Soler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias." "fecha" => "2009" "volumen" => "21" "paginaInicial" => "376" "paginaFinal" => "381" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coronavirus (COVID-19). Accessed 28 March" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Center for Disease Control and Prevention (CDC)" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2020" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MERS transmission and risk factors: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.-E. Park" 1 => "S. Jung" 2 => "A. Kim" 3 => "J.-E. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12889-018-5484-8" "Revista" => array:5 [ "tituloSerie" => "BMC Public Health." "fecha" => "2018" "volumen" => "18" "paginaInicial" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29716568" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ministerio de Sanidad. Prevención y control de la infección en el manejo de pacientes con COVID-19. Disponible: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000003/v1_202008150733/S2387020620302862/v1_202008150733/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000003/v1_202008150733/S2387020620302862/v1_202008150733/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620302862?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 25 | 4 | 29 |
| 2024 September | 27 | 1 | 28 |
| 2024 August | 46 | 1 | 47 |
| 2024 July | 29 | 6 | 35 |
| 2024 June | 15 | 2 | 17 |
| 2024 May | 15 | 3 | 18 |
| 2024 April | 22 | 4 | 26 |
| 2024 March | 16 | 4 | 20 |
| 2024 February | 21 | 3 | 24 |
| 2024 January | 19 | 7 | 26 |
| 2023 December | 33 | 12 | 45 |
| 2023 November | 30 | 8 | 38 |
| 2023 October | 40 | 10 | 50 |
| 2023 September | 21 | 4 | 25 |
| 2023 August | 16 | 6 | 22 |
| 2023 July | 30 | 3 | 33 |
| 2023 June | 39 | 3 | 42 |
| 2023 May | 55 | 2 | 57 |
| 2023 April | 19 | 8 | 27 |
| 2023 March | 9 | 4 | 13 |
| 2023 February | 13 | 7 | 20 |
| 2023 January | 24 | 4 | 28 |
| 2022 December | 37 | 7 | 44 |
| 2022 November | 32 | 11 | 43 |
| 2022 October | 31 | 11 | 42 |
| 2022 September | 42 | 5 | 47 |
| 2022 August | 29 | 12 | 41 |
| 2022 July | 23 | 6 | 29 |
| 2022 June | 29 | 6 | 35 |
| 2022 May | 39 | 7 | 46 |
| 2022 April | 34 | 6 | 40 |
| 2022 March | 39 | 9 | 48 |
| 2022 February | 34 | 7 | 41 |
| 2022 January | 65 | 6 | 71 |
| 2021 December | 58 | 13 | 71 |
| 2021 November | 36 | 6 | 42 |
| 2021 October | 40 | 13 | 53 |
| 2021 September | 32 | 9 | 41 |
| 2021 August | 56 | 11 | 67 |
| 2021 July | 44 | 6 | 50 |
| 2021 June | 28 | 11 | 39 |
| 2021 May | 27 | 10 | 37 |
| 2021 April | 75 | 26 | 101 |
| 2021 March | 32 | 10 | 42 |
| 2021 February | 39 | 13 | 52 |
| 2021 January | 36 | 13 | 49 |
| 2020 December | 34 | 8 | 42 |
| 2020 November | 34 | 12 | 46 |
| 2020 October | 17 | 12 | 29 |
| 2020 September | 20 | 9 | 29 |
| 2020 August | 12 | 17 | 29 |
| 2020 July | 0 | 3 | 3 |
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