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Akash Sharma

How to manage the issue of expiratory filter in Sophie ventilators #COVID 19

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Dear all 

As all of us are preparing ourselves to form potential strategies to mitigate and manage SARS CoV2 positive neonates, we come across various challenges. 

Our NICU has Sophie ventilators which do not have a expiratory filter. So the potentially infectious aerosols would be released in the NICU environment. We have not been able to devise a way to circumvent that yet. Though thankfully there have been no suspect cases so far in Delhi. But in order to prepare for a possible surge it is essential to look at such issues. 

 

Please suggest what is being followed in other units who are currently managing such neonates and suggest the possible solution to the issue that our unit is facing 

 

Thank you

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Hi Akash,

SImple solution would be try and keep the babies in negative pressure isolation rooms and full PPE for the staff taking care of these babies. IF negative pressure is not avaialable then exhaust fans may help in removing these aerosols from the nicu.

Cheers .

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@satyen75 hello sir

Yes sir. Putting in exhausts is a backup plan.. To truly make negative pressure isolation rooms is difficult in this situation. 

Exhausts is a very viable alternative sir.

Thank you. 

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Dear Akash

I wonder if aerosol is a issue in Invasive Neonatal Ventilation . Is there Evidence for it .

May be a issue with NIV and the Nebulisation 

Guide me 

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@Dr Ashish Jain sir

Good evening sir 

Sir the thinking that occurs during the time of intubtaion aerosols would be generated extends to ventilation too. A ventilated infants expired air would be vented out into the NICU atmosphere without being filtered.

Quoting some lines from an article after the SARS Epidemic in Clinics in chest medicine( Attaching the article as well sir) 

"Measures to minimize respiratory droplet transmission include using in-line suctioning to maintain the ventilator circuit as a closed system. Humidification should be done via heat-moisture exchangers with viral-bacterial filter properties rather than heated humidifiers. Each ventilator should have two filters: one between the inspiratory port and ventilator circuit and the other between the expiratory port and ventilator circuit, to provide additional protection from exhaust gases and minimize ventilator contamination."

Kindly provide your valuable opinion on the same 

Thank you

MV SARS.pdf

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Hi Akash,

Just learnt that there are some breathing system filters that can be applied on the expiratory limb. However, they are off label in neonates, they are for single day use only and it adversely affects the compliance and resistance of the circuit and increases dead space and can adversely effect the ventilation  and  the baby also. So rather than thnking about contamination of the enviornment we must save our babies and the lifes of life supporting system i.e. ventilators.  So no clear solution yet.

 

Regards

Dr Satyen

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@satyen75 sir 

Found that there are certain DAR filters ( Electrostatic ones and not just mechanical which can be attached to the expiratory limb)

resistance increment is given as 0.7 cmH20

PFA the PDF file for it and the snapshot of the same 

 

Thank you

 

 

image.png

covidien dar filters.pdf

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Dear Satyan and Akash ,

I still would have serious doubts in the fact and the possibility of a ventilated baby with Flows 8L and the tidal Volume less than 15 ml , generating the aerosols to stay undedicated and contaminate the environment to the level of concern . May be with HFO in some vent that use >30L flows this may be a issue .

Also , as you can see the filters also need a flow of 30L/Min to be optimally functioning , or it is upto 30L is not clear. Better would be to attach the exhalation port with some ...connector to underwater seal with Sodium Hypochlorite ...just a thought 

Regards 

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