Nasal mask-face tent and suctioning provided continuous oxygenation and reduced aerosol/ droplet spread in patient recovered from COVID-19 pneumonia during POEM

ABSTRACT

Background: A modified paediatric facemask has been shown to provide nasal CPAP ventilation/ oxygenation in obese OSA patients during sedation or general anaesthesia induction.1-2 A combined nasal mask-face tent provided continuous oxygenation and reduced aerosol/droplet spread in a COVID-19 positive patient (Fig.1).3 It avoided severe desaturation and reduced aerosol/droplet spread during difficult intubation/extubation in a morbidly obese patient.4 We used it in an obese OSA patient recovered from severe COVID-19 pneumonia undergoing peroral endoscopic myotomy (POEM). Case Report A 60-year-old obese male with OSA, atrial-fibrillation, cardiomyopathy, severe COPD on home O2, previous severe COVID-19 pneumonia s/p convalescent plasma therapy, and achalasia presented for POEM. An infant facemask was secured over his nose and his mouth was covered with a clear plastic sheet (face-tent) to reduce aerosol/droplet spread. Following pre-oxygenation with 4LO2/min, RSI with cricoid pressure was induced with etomidate/propofol/succinylcholine. Video-laryngoscopy-assisted intubation was performed under the face-tent while the nasal mask delivered apnoeic oxygenation (Fig. 1). SpO2 was maintained at 100% throughout. He developed tension pneumoperitoneum with insufflated CO2 which was reduced with 14G angiocatheter x3. Upon awakening, he was agitated and required additional propofol/ fentanyl/ dexmedetomidine and three providers to restrain him in order to provide nasal oxygenation and suction oral secretions for >20 mins (Fig.2). Discussion: This simple nasal mask-face tent provided continuous oxygenation during RSI and intubation in an obese OSA patient with previous severe COVID-19 pneumonia undergoing POEM. It maintained spontaneous CPAP nasal ventilation and oxygenation post-extubation. Combining with oral suctioning, it reduced aerosol/droplet spread. Amid the COVID-19 pandemic, it may optimize patient safety and provide additional provider protection. (Figure Presented).