PPE in intubated Covid19 patients

Is there a need for wearing N95/ FFP2 masks in careing for intubated c19 patients on a ventilator using a filter in the ventilator circuit?

From Everett Washington, we are still using N95/CAPRS for intubated patients on vent even with a filter, I haven’t been able to find good data on this, so we’re still being cautious

We are not, given it is a closed system once they are vented: comfort levels, preservation of PPE etc. I would have thought there would be some practice guidelines/observations/recommendations out of China or Italy and now the US but I am not aware of any myself.

That’s my problem, too. Asked national desease centre (Robert Koch Institut, Germany) but got no answer, yet. Will post it here when I get it…

We use PAPR in COVID positive and PUI patients regardless of intubation/vent.

I would think you would be ok with the vent circuit since it’s closed, however, if the vent is opened at all, isn’t there possibility of aerosolized droplets in the room for some time after reconnecting? I think chance is reduced with negative pressure, but regular rooms I’m still skeptical. Just thinking how many times vents become inadvertently disconnected through the course of a day.

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@Markus_Brucke :we are now switching to N95 use regardless of the vent status, since at times there might be cuff leaks/inadvertently vent disconnections that might happen. There were multiple episodes were they were using surgical masks and then they had to doff add n95 and come back into the room.

At our institution and COVID positive patient is on droplet precaution regardless of vent status. N95, surgical mask, goggles or Visor, heat cover, gown, gloves and shoe covers.

In regards to the ETT balloon, I’ve read some reports that in some other countries they were instilling saline soaked throat packing and changing q24hrs. I’ve never seen it described anywhere else. I don’t think you should rely on the ETT balloon.

This disease is aerosolizing and there are many points where aerosol can be generated. It is also important for us to know about our patients’ rooms regarding negative pressure and Air Changes per Hour ACH:

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