Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test.

Introduction: N95 respirators, together with eye protection, form vital elements of personal protective equipment (PPE) for healthcare workers (HCW) caring for patients with respiratory infections, such as COVID-19. Duckbill N95 respirators are widely used but have a high failure rate when Fit Tested. The commonest site for inward leaks is the region between the nose and maxilla. Safety goggles with an elastic headband may press the upper rim of the respirator against the face, thereby reducing inward leaks. We hypothesized that the use of safety goggles with an elastic headband will improve the overall fit-factor of a duckbill N95 respirator and increase the proportion of users who pass a quantitative Fit Test. Methods: About 60 volunteer HCWs, who had previously failed quantitative Fit Testing with a duckbill N95 respirator, participated in this before-and-after intervention study. A PortaCount® 8048 was used for quantitative Fit Testing. The test was first performed with a duckbill N95 respirator only. It was then repeated after participants donned a pair of safety goggles (3M Fahrenheit, ID 70071531621). Results: Before the intervention, i.e., with the respirator only, 8 (13.3%) participants passed their Fit Test. This increased to 49 (81.7%) after the application of safety goggles (OR 42, 95% CI 7.14-1697.9, p < 0.0001). The adjusted mean overall fit factor, using Tobit regression analysis, increased from 40.3 to 193.0 (t = 12.32, p < 0.001). Conclusion: The use of safety goggles with an elastic headband significantly increases the proportion of users who pass a quantitative Fit Test and improves the fit-factor of a duckbill N95 respirator. How to cite this article: Kamal M, Bhatti M, Stewart WC, Johns M, Collins D, Shehabi Y, et al. Safety Goggles with Elastic Headband to Improve N95 Fit Following Failed Quantitative Fit Test. Indian J Crit Care Med 2023;27(6):386-391.

Author's Reply to "Communication with Patients on Mechanical Ventilation: A Review of Existing Technologies" by Nair and Anand.

How to cite this article: Dind A, Starr JS, Arora S. Author's Reply to "Communication with Patients on Mechanical Ventilation: A Review of Existing Technologies" by Nair and Anand. Indian J Crit Care Med 2022;26(6):758.

iPad-based Apps to Facilitate Communication in Critically Ill Patients with Impaired Ability to Communicate: A Preclinical Analysis.

BACKGROUND: Inability to communicate is very distressing for patients in the intensive care unit (ICU). Most communication exchanges in ICU are initiated by healthcare workers (HCWs). Touch screen apps may enable patients to initiate communication and improve their interactions. OBJECTIVES: This study aimed to evaluate the pertinent features of iPad-based apps designed for communication in ICU. METHODS: Apple "App Store" and Google "Play Store" were searched for keywords "communication" and "intensive care." Related app suggestions were screened. Two independent assessors evaluated iPad-based apps that were deemed useful. The assessors resolved the discrepancies by re-evaluating the apps and reaching a consensus. RESULTS: Nine apps met the inclusion criteria. Of these six apps were free. There were seven apps specific to intensive care. Most apps had preloaded phrases for the patient to request to see someone (e.g., family), personal hygiene (e.g., bowel care), seek help with symptoms (e.g., pain), or a comfort item (e.g., blanket). CALD Assist, Patient Communicator, VidaTalk, and YoDoc were available in more than eight languages. VidaTalk and YoDoc allowed the user to write. Four apps were deemed not suitable for routine ICU use, while the remaining five had several attractive features. CONCLUSION: Several high-quality apps are available to assist with patient-initiated communication exchange in ICU. This study provides a guide for readers to choose the app most suited to their needs. In the opinion of the authors, YoDoc is the most suitable app for routine use in ICU. Among free apps, CommuniCare appears to be the most user-friendly. HOW TO CITE THIS ARTICLE: Dind AJ, Starr JS, Arora S. iPad-based Apps to Facilitate Communication in Critically Ill Patients with Impaired Ability to Communicate: A Preclinical Analysis. Indian J Crit Care Med 2021;25(11):1232-1240.

Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study.

AIM AND OBJECTIVE: Fogging of eyeglasses while wearing N95 respirators is common. It is commonly held that the N95 respirator has a poor fit if there is fogging of eyeglasses. We conducted this prospective, pilot study to determine if fogging of eyeglasses predicts poor fit of N95 respirator. MATERIALS AND METHODS: Seventy volunteer healthcare workers from a tertiary intensive care unit in Sydney, Australia participated. The participants donned one of the following N95 respirators: three-panel flat-fold respirator (3M 1870), cup-shaped respirator (3M 1860), or a duckbill respirator. After a satisfactory "user seal check" as recommended by the manufacturer, the participants donned eyeglasses and checked for fogging. A quantitative fit test (QnFT) of the respirator was then performed (using PortaCount Respirator Fit Tester 8048, TSI Inc., Minnesota, USA). A fit factor of <100 on quantitative fit testing indicates poor fit. The sensitivity and specificity for fogging of eyeglasses (index test) to predict the poor fit of N95 respirator was determined, compared to QnFT (gold standard test). RESULTS: Fogging of eyeglasses as a predictor of poor respirator fit (i.e., fit factor <100 on QnFT) had sensitivity of 71% (95% CI, 54-85%) and specificity 46% (95% CI, 29-63%). The odds ratio of fogging as a predictor for poor fit was 2.10 (95% CI, 0.78-5.67), with a two-tailed p-value of 0.22 (not significant). The receiver operating characteristic curve for fogging of eyeglasses as a diagnostic test had the area under the curve of 0.59. CONCLUSION: Fogging of eyeglasses is neither a sensitive nor a specific predictor for poor fit of N95 respirators. HOW TO CITE THIS ARTICLE: Kyaw S, Johns M, Lim R, Stewart WC, Rojas N, Thambiraj SR, et al. Prediction of N95 Respirator Fit from Fogging of Eyeglasses: A Pilot Study. Indian J Crit Care Med 2021;25(9):976-980.

Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles.

N95 respirators and safety goggles are important components of personal protective equipment to reduce the spread of airborne infections, such as COVID-19, among healthcare workers. Poor N95 respirator seal may reduce its protective effect, thereby increasing transmission. Quantitative fit testing is an established way of assessing the N95 respirator fit, which provides a quantitative measure for seal, called the fit factor. Duckbill N95 respirators frequently fail the fit test. We hypothesized that using safety goggles with a wraparound elastic headband will increase their fit-factor by reinforcing the seal between the face and the upper margin of the respirator. We studied the effect of safety goggles with a wraparound elastic headband (3M™ Chemical Splash Resistant Goggles, ID 70006982741) on the fit factor of two types of Duckbill N95 respirators (Halyard FLUIDSHIELD*3, Model 99SA070M, and ProShield® N95 Model TN01-11) in 63 healthy volunteers in a nonrandomized, before-and-after intervention study design. The mean fit factor increased from 69.4 to 169.1 increased from 17/63 (27%) to 46/63 (73%) after the intervention (p <0.0001, OR 3 [95% CI = 4.9-1223]). This is the first study to explore the impact of safety goggles on N95 respirator fit. We conclude that the use of safety goggles with a wraparound elastic headband increases the fit factor of the tested Duckbill N95 respirators. HOW TO CITE THIS ARTICLE: Johns M, Kyaw S, Lim R, Stewart WC, Thambiraj SR, Shehabi Y, et al. Fit Factor Change on Quantitative Fit Testing of Duckbill N95 Respirators with the Use of Safety Goggles. Indian J Crit Care Med 2021;25(9):981-986.

Physiology of Oxygen Transport and its Determinants in Intensive Care Unit.

Transport of oxygen is one of the most important functions of blood. How oxygen moves from the air, where its partial pressure is about 150 mm Hg to mitochondria, where it drops down to a single digit is an evolutionary marvel. In this article, we discuss the physiology of oxygen transport from the alveoli to the tissue, the alveolar gas equation and the oxyhemoglobin dissociation curve. In the applied physiology section, we discuss the impact of high altitude, hyperbaric conditions, carbon monoxide poisoning on the transport of oxygen. Some common pitfalls in the interpretation of pulse oximetry and arterial blood gas are also discussed. Finally, we talk about the methods of increasing oxygen delivery, the compensation for hypoxia and some indications of venous oxygen saturation measurement. HOW TO CITE THIS ARTICLE: Arora S, Tantia P. Physiology of Oxygen Transport and its Determinants in Intenstive Care Unit. Indian J Crit Care Med 2019;23(Suppl 3):S172-S177.

Respiratory care of patients with cervical spinal cord injury: a review.

Respiratory complications following cervical spinal cord injury are common and are the leading cause of morbidity and mortality after this type of injury. Impaired mechanics of ventilation, poor cough, increased secretions and bronchospasm predispose to atelectasis, pneumonia and exacerbations of respiratory failure. Prolonged mechanical ventilation and tracheostomy are often required. This review discusses the relevant pathophysiology, various ventilatory strategies and timing of tracheostomy, and examines the evidence surrounding physiotherapeutic and pharmacological treatment options.

Comparison of intermittent haemodialysis, prolonged intermittent renal replacement therapy and continuous renal replacement haemofiltration for lithium toxicity: a case report.

This case report compares three types of renal replacement therapy for acute severe lithium toxicity and is the first to use prolonged intermittent renal replacement therapy (PIRRT). A peak lithium level of 13.2mmol/L was recorded after a 51- year-old man attempted suicide. He was treated with intermittent haemodialysis (IHD), PIRRT and continuous venovenous haemofiltration (CVVH) over 55 hours. Lithium clearance was shown to be comparable between IHD and PIRRT, both of which were superior to CVVH. Expected efficacy of treatment with a single daily session of PIRRT was higher than IHD or CVVH. PIRRT is a useful strategy for dialysis among patients with acute lithium intoxication.