Neonatal mannequin comparison of the Upright self-inflating bag and snap-fit mask versus standard resuscitators and masks: leak, applied load and tidal volumes

ObjectiveNeonatal mask ventilation is a difficult skill to acquire and maintain. Mask leak is common and can lead to ineffective ventilation. The aim of this study was to determine whether newly available neonatal self-inflating bags and masks could reduce mask leak without additional load being applied to the face.DesignForty operators delivered 1 min episodes of mask ventilation to a mannequin using the Laerdal Upright Resuscitator, a standard Laerdal infant resuscitator (Laerdal Medical) and a T-Piece Resuscitator (Neopuff), using both the Laerdal snap-fit face mask and the standard Laerdal size 0/1 face mask (equivalent sizes). Participants were asked to use pressure sufficient to achieve ‘appropriate’ chest rise. Leak, applied load, airway pressure and tidal volume were measured continuously. Participants were unaware that load was being recorded.ResultsThere was no difference in mask leak between resuscitation devices. Leak was significantly lower when the snap-fit mask was used with all resuscitation devices, compared with the standard mask (14% vs 37% leak, P<0.01). The snap-fit mask was preferred by 83% of participants. The device-mask combinations had no significant effect on applied load.ConclusionsThe Laerdal Upright Resuscitator resulted in similar leak to the other resuscitation devices studied, and did not exert additional load to the face and head. The snap-fit mask significantly reduced overall leak with all resuscitation devices and was the mask preferred by participants.

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Making cotton face masks extra-protective by use of impervious cloth as the front layer to restrict flow of aerosols and droplets

10.1101/2020.07.30.20165563 ◽

2020 ◽

Author(s):

Priyanka L Shahane-Kapse ◽

Moreshwar R Shende ◽

Sumit Kar ◽

Pradeep Deshmukh ◽

Dhiraj Bhandari ◽

...

Keyword(s):

Single Layer ◽

Middle Layer ◽

Face Mask ◽

The Other ◽

Outer Side ◽

Carbol Fuchsin ◽

Triple Layer ◽

Impervious Layer ◽

Surgical Masks ◽

The Face

Introduction: One of the important measures to prevent spread of COVID-19 in community is use of face mask. Though the debate is going on regarding the airborne transmission of SARS-CoV-2 it makes reasonable point for universal use of face masks. A large variety of face masks are available in the market or people can make their own using household items. The efficacy of masks depends upon the type of cloth and number of layers of the cloth. Material and methods: We have created an innovative mask with two layers of cotton and an impervious layer. The impervious layer made from polypropylene coated with polyurethane was applied on the outer side in the middle half of the mask in front of mouth and nose. The efficacy of this test mask was measured against N95FFR (reference standard), triple layer surgical masks and single layer cotton mask. A manikin was used wearing these masks/respirator and aerosols/droplets of diluted red colored carbol fuchsin and fluorescent Auramine O were sprayed from distance of 1m and 2m. We also tested use of face shield. Both macroscopic and microscopic examination of the dissected masks and respirator was performed. Results: The N95FFR was able to block the aerosols/droplets by its front layer. One triple layer surgical mask showed microscopic presence of stain in its innermost layer while the other blocked it with middle layer. The single layer cotton mask was not able to protect as we observed stain on the face itself. The test mask blocked most of the stain on impervious layer and also on the front cotton layer on lateral sides, where impervious layer was absent. When fluorescent stain was used, ultraviolet examination demonstrated that the whole area covered by test mask was clean while the other non covered area was fluorescent. Conclusion: We believe that our innovation can be used in the community as well as in general areas of the hospital like, offices, labs, etc. and can be a better alternative to single use triple layer surgical masks. Further testing may be done by other organizations to rule out bias in our study.

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Face masks as layers of meaning in times of COVID-19

Culture & Psychology ◽

10.1177/1354067x20957549 ◽

2020 ◽

pp. 1354067X2095754

Author(s):

Luca Tateo

Keyword(s):

University Students ◽

Everyday Life ◽

Cultural Psychology ◽

Meaning Making ◽

Face Mask ◽

The Other ◽

Different Types ◽

The Face ◽

The Way

The pandemic of COVID-19 has brought to the front a particular object: the face mask. I have explored the way people make-meaning of an object generally associated with the medical context that, under exceptional circumstances, can become a presence in everyday life. Understanding how people make meaning of their use is important. Using cultural psychology, I analyse preferences toward different types of face masks people would wear in public. The study involved 2 groups, 44 Norwegian university students and 60 international academics. In particular, I have focused on the role of the mask in regulating people affective experience. The mask evokes safety and fear, it mediates in the auto-dialogue between “I” and “Me” through the “Other”, and in the hetero-dialogue between “I” and the “Other” through “Me” The dialogue is characterized by a certain ambivalence, as expected. Meaning-making is indeed the way to deal with the ambivalence of human existence.

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Assessment of Pulmonary Mechanics and Gastric Inflation Pressure During Mask Ventilation

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041807 ◽

1995 ◽

Vol 10 (2) ◽

pp. 101-105 ◽

Cited By ~ 82

Author(s):

Norbert Weiler ◽

Wolfgang Heinrichs ◽

Wolfgang Dick

Keyword(s):

Lung Function ◽

Time Constant ◽

Face Mask ◽

Pulmonary Mechanics ◽

Mask Ventilation ◽

Inflation Pressure ◽

The Face ◽

Urological Procedures ◽

The Mean ◽

Mean Compliance

AbstractIntroduction:Mask ventilation is a procedure routinely used in emergency medicine. Potential hazards are inadequate alveolar ventilation and inflation of the stomach with air, leading to subsequent regurgitation and aspiration. The aim of this study was to measure lung function and gastric inflation pressures during mask ventilation.Methods:For this purpose, 31 patients scheduled for routine urological procedures were studied during induction of anesthesia. Lung function was assessed by recording respiratory flow and pressure directly at the face mask. Gastric inflation was observed with a microphone taped to the epigastric area.Results:Gastric inflation occurred in 22 of the 31 patients. Mean gastric inflation pressure was 27.5 ±6.55 cm H2O, mean compliance was 67 ±24.1 ml/cm H2O, mean resistance was 17.4 ±6.41 cm H2O/L/sec, and the mean respiratory time constant was 1.1 ±0.26 seconds.Conclusions:These data suggest that inspiratory pressure be limited to 20 cm H2O, and that an inspiratory time of at least four times the respiratory time constant be allowed. Monitoring airway pressure and gastric inflation is a simple technique that may improve the safe-ty of patients during mask ventilation.

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Continuous positive airway pressure face-mask ventilation to manage massive influx of patients requiring respiratory support during the SARS-CoV-2 outbreak

10.1101/2020.06.01.20118018 ◽

2020 ◽

Author(s):

S. Alviset ◽

Q. Riller ◽

J. Aboab ◽

K. Dilworth ◽

PA. Billy ◽

...

Keyword(s):

Respiratory Failure ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Face Mask ◽

Respiratory Support ◽

Mask Ventilation ◽

Invasive Ventilation ◽

Massive Influx ◽

High Flow Oxygen

AbstractBackgroundSince December 2019, a global outbreak of coronavirus disease (COVID-19) is responsible for massive influx of patients with acute respiratory failure in hospitals. We describe the characteristics, clinical course, and outcomes of COVID-19 patients treated with continuous positive airway pressure (CPAP) in a large public hospital in France.MethodIt is a single centre retrospective observational cohort. From 27th March to 23rd April, consecutive patients who had signs of respiratory failure or were unable to maintain an SpO2 > 90%, despite receiving 10 to 15 l/min of oxygen with a non-rebreather mask, were treated by CPAP with a face-mask unless the ICU physician judged that immediate intubation was indicated. The main outcomes under study were reasons for CPAP discontinuation and mortality.ResultsA total of 585 patients were admitted in Delafontaine hospital for severe COVID-19. ICU was quickly overwhelmed. Fifty-nine out of 159 (37%) patients requiring ICU care had to be referred to other hospitals. CPAP therapy was initiated in 49 patients and performed out of ICU in 41 (84%). SARS-CoV2 pneumonia was confirmed by PCR from respiratory tract in 39 (79%) patients and by thoracic CT scan in the remaining patients. CPAP was performed out of ICU in 41 (84%) cases. Median age was 65 years (IQR=54-71). Median duration of CPAP treatment was 3 days (IQR=1-5). Reasons for discontinuation of CPAP were intubation for invasive ventilation in 25 (51%) patients, improvement in 16 (33%), poor tolerance in 6 (12%) and death in 2 (4%). A decision not to intubate had been taken for the 2 patients who died while on CPAP.ConclusionsTreatment with CPAP is feasible and safe in a non-ICU environment in the context of a massive influx of patients. One third of these patients with high oxygen requirements did not eventually need invasive ventilation.Key messagesWhat is the key question?What is the best respiratory support strategy to manage a massive influx of patients with hypoxemic respiratory failure despite high-flow oxygen delivered with a non-rebreather mask?What is the bottom line?Continuous positive airway pressure face mask ventilation delivered in non-ICU wards to patients who do not require immediate intubation is feasible and safe.Why read on?Face mask ventilation with CPAP should be considered as an option of respiratory support in the context of the on-going COVID-19 pandemic and limited availability of ICU beds.

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Comparison of intra-oral mask and classic face mask in terms of ventilation success and practitioners’ work load assessments: a randomized crossover study

10.22541/au.161977206.60970943/v1 ◽

2021 ◽

Author(s):

Mikail ALKAN ◽

İsmail Aytaç ◽

Betül GÜVEN AYTAÇ ◽

Hidayet ÜNAL ◽

Bahattin GÜRSUL ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Tidal Volume ◽

Body Mass ◽

Potential Risk ◽

Work Load ◽

Face Mask ◽

Mask Ventilation ◽

Mallampati Score ◽

Potential Risk Factors

Aim: Providing effective ventilation of the unconscious patient is an essential skill in every specialty dealing with airway management. In this randomized cross-over study aimed to compare intra-oral and classic face mask in terms of ventilation success of patients, practitioners’ workload and anxiety assessments. Also we analyzed potential risk factors of difficult mask ventilation for both masks. Methods: 24 anesthesiology residents and 12 anesthesiologists participated in the study. Each of the practitioners ventilated 4 patients with both masks at settled pressure and frequency. Practitioners rated their workload and anxiety related to masks with National Aeronautics and Space Administration Task Load Index score and State Trait Anxiety Inventory scale. Ventilation success was evaluated with Han scale, expiratory tidal volume and leak volume. We analyzed potential risk factors of difficult mask ventilation with anthropometric characteristics and STOP-BANG score. Results: Ventilation success rate was superior with intraoral mask comparing to classic face mask in terms of Han Scale (Easy mask ventilation percentage 84/144 (58.3%); 123/144 (85.4%); respectively) and tidal volume (481.92±173.99; 430.85±154.87mL; respectively). Leak volume in intraoral mask ventilation was significantly lower than classic face mask (71.50±91.17 /159.38±146.31 respectively). Diffucult mask ventilation risk factors were high weight, neck circumference, Mallampati score and STOP-BANG score>3 for classic face mask (at the utmost neck circumference 95% CI, OR=1.180, p= 0.002) Risk factors were high body mass index and Mallampati score for intraoral mask (at the utmost Body mass index 95% CI, OR=1.162 p=0.006). The anxiety ratings of practitioners were similar between two masks. The work-load rating is higher with intraoral mask comparing to classic face mask. Conclusion: Intraoral mask may be an effective alternative device for bag-valve mask ventilation.

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A COMPARISON OF MOUTH-TO-MOUTH, MOUTH-TO-POCKET FACE MASK AND BAG VALVE MASK VENTILATION DURING LIFEGUARDS’ CPR: A MANIKIN STUDY

Emergency Medical Service ◽

10.36740/emems202101107 ◽

2021 ◽

Vol 8 (1) ◽

pp. 13-17

Author(s):

Tomasz Gaszyński ◽

Bartosz Borkowski ◽

Karolina Przybyt-Sibelska ◽

Krzysztof Chmiela

Keyword(s):

Tidal Volume ◽

Artificial Ventilation ◽

Average Length ◽

Face Mask ◽

Mask Ventilation ◽

Chest Compressions ◽

Manikin Study ◽

Ventilation Effectiveness ◽

Ventilation Method

Aim: To compare the effectiveness of ventilation of each of three methods: mouth-to-mouth ventilation using a foil face mask with a filter pad, mouth-to-mask technique with a pocket face mask and bag valve mask ventilation using a self-inflating bag and a face mask, performed during CPR by qualified non-medical rescuers. Material and methods: Ventilation effectiveness was assessed on manikin and compared for mouth-to-mouth, mouth-to-mask and bag valve mask ventilation method. 46 qualified non-medical rescuers-lifeguards participated in the study. Tidal Volume of 0,4-0,7L was considered as effective. The length of chest compressions pauses was recorded. The ventilation methods were also evaluated subjectively by participants in the questionnaire. Results: Effectiveness 90,75% vs. 92,38% vs. 69,5%; average number of effective rescue breaths: 7,26 vs. 7,39 vs. 5,65; average length of chest compressions pause: 7,7s vs. 8,1s vs. 9,9s for MTM, MPFM and BMV respectively. MPFM method was considered as the easiest, the second in terms of the difficulty in use was MTM, and BMV was described as the most difficult to use. Conclusions: Artificial ventilation using the pocket mask, in the course of resuscitation performed by one qualified non-medical rescuer, e.g. the water lifeguard, is an effective method ensuring adequate tidal volume and is more effective than mouth-to-mouth method and bag valve mask ventilation.

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Effects of negative upper airway pressure on pattern of breathing in sleeping infants

Journal of Applied Physiology ◽

10.1152/jappl.1989.66.4.1599 ◽

1989 ◽

Vol 66 (4) ◽

pp. 1599-1605 ◽

Cited By ~ 12

Author(s):

B. T. Thach ◽

A. P. Menon ◽

G. L. Schefft

Keyword(s):

Tidal Volume ◽

Airway Pressure ◽

Upper Airway ◽

Face Mask ◽

Inhibitory Effect ◽

Lower Airway ◽

Quiet Sleep ◽

Reflex Mechanism ◽

Inspiratory Muscles ◽

Reflex Latency

Negative upper airway (UAW) pressure inhibits diaphragm inspiratory activity in animals, but there is no direct evidence of this reflex in humans. Also, little is known regarding reflex latency or effects of varying time of stimulation during the breathing cycle. We studied effects of UAW negative pressure on inspiratory airflow and respiratory timing in seven tracheostomized infants during quiet sleep with a face mask and syringe used to produce UAW suction without changing lower airway pressure. Suction trials lasted 2–3 s. During UAW suction, mean and peak inspiratory airflow as well as tidal volume was markedly reduced (16–68%) regardless of whether stimulation occurred in inspiration or expiration. Reflex latency was 42 +/- 3 ms. When suction was applied during inspiration or late expiration, the inspiration and the following expiration were shortened. In contrast, suction applied during midexpiration prolonged expiration and tended to prolong inspiration. The changes in flow, tidal volume, and timing indicate a marked inhibitory effect of UAW suction on thoracic inspiratory muscles. Such a reflex mechanism may function in preventing pharyngeal collapse by inspiratory suction pressure.

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‘Omani Burqa’ vs. Decorated Façade of Modern Omani House; the Case of Salalah, Dhofar Region, Oman

The Academic Research Community Publication ◽

10.21625/archive.v2i3.350 ◽

2018 ◽

Vol 2 (3) ◽

pp. 101

Author(s):

Balkiz Yapicioglu ◽

Liudmila Cazacova

Keyword(s):

Architectural Design ◽

Visual Analysis ◽

Face Mask ◽

The Other ◽

Overall Design ◽

Architectural Elements ◽

Traditional Design ◽

Visual Access ◽

The Face ◽

Closed Society

Visiting Oman, one firstly encounters wide roads and exaggerated decorations of house façades—situated behind high walls. These broad roads and decorated dwellings are unlike traditional Omani architecture which can be identified as very sensitive to scale and climate. Omani architecture can also be visualized from the narrow streets and low height buildings across many well-preserved villages; built using humble mud or stone structures. Another encounter one might have is the traditional ‘Omani burqa.’ It is worn by some Omani women, originally designed for protection from dust and sand, which mimics the features of a falcon. Lately, the ‘Omani burqa’ has developed into a true fashion-item and is used as a ‘face mask’ with different colors and shapes. Fashionable burqas are often decorated with shimmering crystals or diamonds which differs from the traditional design. What is visible behind the ‘burqa’, the ‘eye’, and the ‘burqa’ itself, become quite embellished, subsiding the importance of the other parts of the face. The façade design of a modern Omani house and its walls are like the modern ‘burqa’ and the ‘eye’. Even though the house is separated from the street by high walls, the importance of visual access from the street to façade can be perceived from the highly decorated house façades, and decorated walls at the same time. This study—using visual analysis of house façades in Salalah, Oman—attempts to identify the architectural elements used in architectural design. These elements are repeated all over Oman, to accentuate visibility from the street to the façade. Eventually, the study concludes that the importance of the visuality from the street to the façade, in a changing ‘closed’ society, is the leading factor for the embellishment of the wall and the façades, rendering the overall design behind the wall insignificant.

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A mask that masked the diagnosis!

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1179 ◽

2021 ◽

Vol 2 (3) ◽

Author(s):

Mohammad-Reza Mohajeri-Tehrani ◽

◽

Neda Hatami ◽

Keyword(s):

Weight Gain ◽

Thyroid Function ◽

Thyroid Disease ◽

Face Mask ◽

Medical Data ◽

Chief Complaint ◽

The Other ◽

Thyroid Function Tests ◽

The Face ◽

One Year

A 31-year-old woman presented with chief complaint of muscle weakness. As this complaint was the most bothersome of all, the patient forgot to mention many other problems that she had. Asking her to remove the face-mask, made us to look for other problems because the typical moon face was masked under the mask!. The other problems were recent weight gain, purple striae on the abdomen, easy bruising and skin acne. She didn’t have hypertension. By reviewing her medical data we found out she had diabetes and was taking metformin. She used to have mild exophthalmos one year ago and thought to be due to thyroid disease but thyroid function tests were normal.

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