Publications by authors named "Amnah Alolaiwat"

4 Publications

  • Page 1 of 1

Mitigating Fugitive Aerosols during Aerosol Delivery via High-Flow Nasal Cannula Devices.

Respir Care 2021 Nov 17. Epub 2021 Nov 17.

Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.

Aerosol delivery via high-flow nasal cannula (HFNC) has attracted clinical interests in recent years. However, both HFNC and nebulization are categorized as aerosol generating procedures (AGPs). In-vitro studies raised concerns that AGPs had high transmission risk. Very few in-vivo studies examined fugitive aerosols with HFNC and nebulization via HFNC, and effective methods to mitigate aerosol dispersion are unknown. Two HFNC devices (Airvo2 and Vapotherm) with or without a vibrating mesh nebulizer (VMN) were compared; HFNC alone, surgical mask over HFNC interface, and HFNC with face tent scavenger were used in a random order for nine healthy volunteers. Fugitive aerosol concentrations at sizes of 0.3-10 µm were continuously measured by particle sizers placed at one and three feet from participants. On a different day, six of the nine participants received six additional nebulizer treatments via VMN or small volume nebulizer (SVN) with mouthpiece with/without an expiratory filter or facemask. In-vitro simulation was employed to quantify inhaled dose with VMN via Airvo2 and Vapotherm. Compared to baseline, neither HFNC device generated higher aerosol concentrations. Compared to HFNC alone, VMN via Airvo2 generated higher 0.3-1.0 µm particles (all p<.05) but VMN via Vapotherm did not. Concentrations of 1.0-3.0 µm particles with VMN via Airvo2 were similar with VMN and a mouthpiece/facemask but lower than SVN with a mouthpiece/facemask (all p<.05). Placing a surgical mask over HFNC during nebulization reduced 0.5-1.0 µm particles (all p<.05) to levels similar to the use of a nebulizer with mouthpiece and expiratory filter. In-vitro the inhaled dose with VMN via Airvo2 was ≥6 times higher than VMN via Vapotherm. During aerosol delivery via HFNC, Airvo2 generated higher inhaled dose and consequently higher fugitive aerosols than Vapotherm. Simple measures, such as placing a surgical mask over nasal cannula during nebulization via HFNC, could effectively reduce fugitive aerosol concentrations.
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http://dx.doi.org/10.4187/respcare.09589DOI Listing
November 2021

Efficacy of Various Mitigation Devices in Reducing Fugitive Emissions from Nebulizers.

Respir Care 2021 Nov 9. Epub 2021 Nov 9.

Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL.

Fugitive aerosol concentrations generated by different nebulizers and interfaces , and mitigation of aerosol dispersion into the environment with various commercially available devices are not known. Nine healthy volunteers were given 3 mL saline with a small volume nebulizer (SVN) or vibrating mesh nebulizer (VMN) with a mouthpiece, a mouthpiece with an exhalation filter, an aerosol mask with open ports for SVN and a valved facemask for VMN, and a facemask with a scavenger (Exhalo) in random order. Five of the participants received treatments using a face tent scavenger (Vapotherm) and a mask with exhalation filter with SVN and VMN in a random order. Treatments were performed in an ICU room, with 2 particle counters positioned 1 and 3 feet from participants measuring aerosol concentrations at sizes of 0.3-10 µm at baseline, before, during and after each treatment. The Ethics Committee at Rush University approved this study. Fugitive aerosol concentrations were higher with SVN than VMN and higher with a facemask than a mouthpiece. Adding an exhalation filter to a mouthpiece reduced aerosol concentrations of 0.3-1.0 µm in size for VMN and 0.3-3.0 µm for SVN (all p<0.05). An Exhalo scavenger over the mask reduced 0.5-3.0 µm sized particle concentrations for SVN (all p<0.05) but not VMN. Vapotherm scavenger and filter facemask reduced fugitive aerosol concentrations regardless of the nebulizer type. SVN produced higher fugitive aerosol concentrations than VMN, while facemasks generated higher aerosol concentrations than mouthpieces. Adding an exhalation filter to the mouthpiece or a scavenger to the facemask reduced aerosol concentrations for both SVN and VMN. Vapotherm scavenger and filter facemask reduced fugitive aerosol as effectively as a mouthpiece with an exhalation filter. This study provides guidance for reducing fugitive aerosol emissions from nebulizers in clinical practice.
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http://dx.doi.org/10.4187/respcare.09546DOI Listing
November 2021

Early versus late awake prone positioning in non-intubated patients with COVID-19.

Crit Care 2021 09 17;25(1):340. Epub 2021 Sep 17.

Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 600 S Paulina St, Suite 765, Chicago, IL, USA.

Background: Awake prone positioning (APP) is widely used in the management of patients with coronavirus disease (COVID-19). The primary objective of this study was to compare the outcome of COVID-19 patients who received early versus late APP.

Methods: Post hoc analysis of data collected for a randomized controlled trial (ClinicalTrials.gov NCT04325906). Adult patients with acute hypoxemic respiratory failure secondary to COVID-19 who received APP for at least one hour were included. Early prone positioning was defined as APP initiated within 24 h of high-flow nasal cannula (HFNC) start. Primary outcomes were 28-day mortality and intubation rate.

Results: We included 125 patients (79 male) with a mean age of 62 years. Of them, 92 (73.6%) received early APP and 33 (26.4%) received late APP. Median time from HFNC initiation to APP was 2.25 (0.8-12.82) vs 36.35 (30.2-75.23) hours in the early and late APP group (p < 0.0001), respectively. Average APP duration was 5.07 (2.0-9.05) and 3.0 (1.09-5.64) hours per day in early and late APP group (p < 0.0001), respectively. The early APP group had lower mortality compared to the late APP group (26% vs 45%, p = 0.039), but no difference was found in intubation rate. Advanced age (OR 1.12 [95% CI 1.0-1.95], p = 0.001), intubation (OR 10.65 [95% CI 2.77-40.91], p = 0.001), longer time to initiate APP (OR 1.02 [95% CI 1.0-1.04], p = 0.047) and hydrocortisone use (OR 6.2 [95% CI 1.23-31.1], p = 0.027) were associated with increased mortality.

Conclusions: Early initiation (< 24 h of HFNC use) of APP in acute hypoxemic respiratory failure secondary to COVID-19 improves 28-day survival. Trial registration ClinicalTrials.gov NCT04325906.
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http://dx.doi.org/10.1186/s13054-021-03761-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446738PMC
September 2021

Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study.

Br J Anaesth 2021 01 10;126(1):48-55. Epub 2020 Oct 10.

Department of Respiratory Care, Rush University Medical Center, Chicago, IL, USA; Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL, USA. Electronic address:

Background: The role of repeated prone positioning in intubated subjects with acute respiratory distress syndrome caused by COVID-19 remains unclear.

Methods: We conducted a retrospective observational cohort study of critically ill intubated patients with COVID-19 who were placed in the prone position between March 18, 2020 and March 31, 2020. Exclusion criteria were pregnancy, reintubation, and previous prone positioning at a referring hospital. Patients were followed up until hospital discharge. The primary outcome was oxygenation assessed by partial pressure of oxygen/fraction of inspired oxygen ratio (Pao/Fio) ratio. A positive response to proning was defined as an increase in Pao/Fio ratio ≥20%. Treatment failure of prone positioning was defined as death or requirement for extracorporeal membrane oxygenation (ECMO).

Results: Forty-two subjects (29 males; age: 59 [52-69] yr) were eligible for analysis. Nine subjects were placed in the prone position only once, with 25 requiring prone positioning on three or more occasions. A total of 31/42 (74%) subjects survived to discharge, with five requiring ECMO; 11/42 (26%) subjects died. After the first prone positioning session, Pao/Fio (mean (standard deviation)) ratio increased from 17.9 kPa (7.2) to 28.2 kPa (12.2) (P<0.01). After the initial prone positioning session, subjects who were discharged from hospital were more likely to have an improvement in Pao/Fio ratio ≥20%, compared with those requiring ECMO or who died.

Conclusion: Patients with COVID-19 acute respiratory distress syndrome frequently responded to initial prone positioning with improved oxygenation. Subsequent prone positioning in subjects discharged from hospital was associated with greater improvements in oxygenation.
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http://dx.doi.org/10.1016/j.bja.2020.09.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547633PMC
January 2021
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