Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients (Part 2)
The risk of respiratory failure requiring critical care support in patients infected with 2019-nCoV is significant, so critical care and anesthesiology teams must be prepared for the arrival and sustained care of patients infected with 2019-nCoV
The Public Health Agency of Canada has released interim infection control recommendations related to 2019-nCoV.
Although the predominant mechanism of transmission is thought to be contact/droplet spread related to respiratory secretions, under circumstances relevant to critical care and anesthesia clinicians, airborne transmission may occur.
Recommended PPE for contact with critically ill patients with confirmed or suspected 2019-nCoV infection include fluid-resistant gown, gloves, eye protection, full face shield and fit-tested N95 respirators
One area of controversy relates to the use of powered air purifying respirators (PAPRs) instead of N95 masks for aerosol-generating procedures.
Although PAPRs have a higher protective factor compared with N95 respirators, there is no definitive evidence that PAPRs reduce the likelihood of viral transmission in the setting of potential airborne spread.
Nonetheless, PAPRs may be more comfortable to wear for prolonged resuscitations, eliminate concerns of unexpected poor N95 respirator fit, and are less likely to be dislodged when managing an agitated patient.
Given that healthcare workers became infected during resuscitation of patients with SARS despite wearing N95 masks, the use of PAPRs is reasonable for high-risk resuscitation scenarios performed on patients with confirmed or suspected 2019-nCoV infection.
The psychologic effects of perceived risk to healthcare providers and the public, especially for those with confirmed or suspected 2019-nCoV infection, cannot be ignored.
Clear and transparent communication from governments and healthcare facilities to staff and public will be essential.
