Eficacia de la mascarilla facial con filtro de partículas N95 y de la mascarilla quirúrgica durante la respiración humana: dos vías para la penetración de partículas.

RESUMENEl nivel de protección ofrecido por las mascarillas con filtro de partículas y las mascarillas se establece considerando el porcentaje de partículas ambientales que penetran dentro del dispositivo de protección. Existen dos vías de penetración: (1) la infiltración a través del sellado facial de la mascarilla y (2) a través del medio filtrante. El objetivo principal de este estudio fue diferenciar el aporte proveniente de cada una de estas dos vías para partículas cuyo tamaño oscila entre 0.03-1 µm en condiciones de respiración reales. Así, mientras se realizaban pruebas de ajuste convencionales, se evaluaron una mascarilla respiratoria autofiltrante N95 y una mascarilla quirúrgica usada comúnmente en entornos de atención médica en 25 sujetos (número coincidente con el último panel de pruebas de ajuste del Instituto Nacional de Seguridad y Salud Laborales). Asimismo, ambas mascarillas fueron evaluadas empleando maniquíes de respiración que imitaban de forma precisa los patrones de respiración registrados previamente en los sujetos evaluados. Posteriormente, se compararon los datos de penetración obtenidos en las evaluaciones realizadas con sujetos humanos y con maniquíes para determinar los diferentes tamaños de partículas, así como los patrones de respiración. Así se determinaron 5,250 valores de penetración específicos correspondientes al ejercicio y el tamaño de las partículas. Para cada valor se calcularon la tasa de infiltración a través del sellado facial de la mascarilla y la tasa de infiltración a través del filtro, con la finalidad de cuantificar los aportes relativos realizados por cada vía de penetración. El número de partículas que penetra mediante infiltración del sellado facial de la mascarilla autofiltrante/mascarilla quirúrgica probadas excedió ampliamente el número de aquellas que lo hacen a través del filtro. Para la mascarilla autofiltrante N95, el exceso fue (en promedio) de un orden de magnitud y se incrementó notablemente al aumentar el tamaño de las partículas (p < 0.001): ∼7 veces mayor para 0,04 µm, ∼10 veces para 0.1 µm y ∼20 veces para 1 µm. En el caso de la mascarilla quirúrgica, la tasa de infiltración a través del sellado facial de la misma con respecto al filtro osciló entre 4.8 y 5.8 y no se vio significativamente afectada por el tamaño de las partículas para la fracción del submicrómetro evaluado. El movimiento facial/corporal tuvo un efecto pronunciado en el aporte relativo de las dos vías de penetración. La intensidad de la respiración y las dimensiones faciales mostraron alguna influencia (aunque limitada). Considerando que la mayoría de las partículas que penetraron ingresaron a través del sellado facial, al desarrollar la mascarilla autofiltrante/mascarilla quirúrgica la prioridad debería ser realizar una adecuación que permitiera eliminar o minimizar la infiltración a través del sellado facial y no mejorar la eficiencia del medio de filtro.

Control de la fuente respiratoria mediante el uso de una mascarilla quirúrgica: un estudio in vitro.

RESUMENLa etiqueta para la tos y la higiene respiratoria son formas de control de la fuente de emisión cuyo uso se alienta para evitar la propagación de infecciones respiratorias. El uso de mascarillas quirúrgicas como medio de control de la fuente en términos de reducción de la exposición de terceros no se ha investigado. En este estudio diseñamos un modelo in vitro utilizando varias mascarillas faciales con el fin de evaluar su aporte a la reducción de la exposición cuando son utilizadas en la fuente infecciosa (Fuente) en comparación con la reducción proporcionada por las mascarillas usadas para la protección primaria (Receptor), así como los factores que contribuyen a cada una. En una cámara con diversos flujos de aire se exhalaron aerosoles radiomarcados desde una cabeza de maniquí de cara blanda ventilada, utilizando respiración periódica y tos (Fuente). En otro maniquí, al que se le colocó un filtro, se cuantificó la exposición del Receptor. Se probaron una mascarilla quirúrgica de ajuste natural, una mascarilla quirúrgica de ajuste seguro (SecureFit) y una mascarilla respiratoria autofiltrante de clase N95 (comúnmente conocida como "mascarilla autofiltrante N95") con y sin sello de vaselina. Con la tos, el control de la fuente (mascarilla quirúrgica/autofiltrante colocada en la Fuente) fue estadísticamente superior a la protección brindada por la mascarilla quirúrgica/mascarilla autofiltrante sin sellar en el Receptor (protección del Receptor) en todos los entornos. Para igualar el control de la fuente durante la tos, la mascarilla autofiltrante N95 debe estar sellada con vaselina. Durante la respiración periódica, el control de la fuente fue comparable o superior a la protección brindada por la mascarilla quirúrgica/autofiltrante en el Receptor. El control de la fuente mediante mascarillas quirúrgicas puede ser una importante defensa adicional contra la propagación de infecciones respiratorias. El ajuste de la mascarilla quirúrgica/autofiltrante combinado con los patrones de flujo de aire en un entorno determinado contribuye de manera significativa a la eficacia del control de la fuente. Los futuros ensayos clínicos deberían incluir un brazo de control de la fuente con mascarilla quirúrgica a fin de evaluar el aporte realizado por el control de la fuente a la protección general contra infecciones de transmisión aérea.

¿Cómo afecta la frecuencia respiratoria el desempeño de una mascarilla respiratoria autofiltrante N95 y de una mascarilla quirúrgica contra sustitutos de partículas virales?

ResumenLa frecuencia respiratoria (respiraciones/min) difiere entre los individuos y dependiendo de los niveles de actividad física. Las partículas ingresan a las mascarillas respiratorias mediante dos vías principales de penetración: infiltración a través del sellado facial y penetración a través de filtros. Sin embargo, se desconoce la forma en que la frecuencia respiratoria afecta el desempeño general de las mascarillas autofiltrantes N95 (filtering facepiece respirators, FFR) y las mascarillas quirúrgicas (MQ) contra partículas virales y otras partículas submicrómicas de importancia para la salud. En un maniquí de respiración a cuatro flujos inspiratorios medios (FIM) (15, 30, 55 y 85 L/min) y cinco frecuencias respiratorias (10, 15, 20, 25 y 30 respiraciones/min) se probaron una FFR y una MQ. En los dispositivos de protección respiratoria probados se determinaron la penetración a través del filtro (Pfiltro) y la infiltración total hacia el interior (ITI) de partículas de aerosol de cloruro de sodio (NaCl) en tamaños que oscilaban entre 20 y 500 nm. Asimismo, se calcularon las proporciones de penetración de la "infiltración a través del sellado facial con respecto al filtro" (ISFF). Tanto el FIM como la frecuencia respiratoria mostraron efectos significativos (p < 0.05) en el Pfiltro y la ITI. El aumento de la frecuencia respiratoria incrementó la ITI para las FFR N95 mientras que en las MQ no se observaron tendencias claras. El aumento del FIM incrementó la Pfiltro y disminuyó la ITI, lo que dio lugar a una disminución de la proporción de la ISFF. La mayoría de las proporciones de la ISFF fueron >1, lo que sugiere que la infiltración a través del sellado facial fue la vía primaria de penetración de partículas a diversas frecuencias respiratorias. La frecuencia respiratoria es otro factor (además del FIM) que puede afectar significativamente el desempeño de las FFR N95: las frecuencias respiratorias más altas aumentan la ITI. En el caso de las MQ probadas no se observó ninguna tendencia consistente de aumento o disminución de la ITI relacionada con el FIM o la frecuencia respiratoria. Para ampliar potencialmente estos hallazgos más allá del maniquí/sistema respiratorio utilizado, se necesitan estudios futuros orientados a comprender plenamente el mecanismo que hace que la frecuencia respiratoria afecte el desempeño de los dispositivos de protección respiratoria en los sujetos humanos.

Impact on COVID-19 morbidity and mortality according to the regulations on the use of face mask.

INTRODUCTION: Currently, the face mask represents an incomparable symbol whose value went from clinical work to impacting the containment of the spread of SARS-CoV-2, although it has become an element of discord in the general population. OBJECTIVE: To establish the impact of face mask use policies on COVID-19 morbidity and mortality. METHODS: Face mask use policy variables, obtained from the website of the #Masks4All scientific movement, were associated with the number of infections, deaths and flattening of the curve published by the Johns Hopkins University resource center and EndCoronavirus.org. RESULTS: Face mask use policies were universal (required in shops, restaurants, public transport), partial (recommended, required in any public place) and absent. Associations of the face mask use policy with total cases (p = 0.01), cases per million (p = 0.04) and deaths per million population (p = 0.02) were statistically significant. Associations of the variables with the epidemiological curve trend were also statistically significant (p = 0.00). CONCLUSION: The recommendation for face mask widespread use is a measure with sufficient scientific support to reduce the number of COVID-19-related infections and deaths.

INTRODUCCIÓN: Actualmente, la mascarilla representa un símbolo incomparable cuyo valor pasó del trabajo clínico a impactar en la contención de la propagación del virus SARS-CoV-2; se convirtió en un elemento de discordia en la población general. OBJETIVO: Establecer el impacto de las políticas de uso de mascarilla en la morbimortalidad por COVID-19. MÉTODOS: Se asociaron las variables de política de uso de cubrebocas, obtenidas de la página web del movimiento científico #Masks4All, con el número de contagios, muertes y aplanamiento de la curva publicados por el centro de recursos de la Universidad Johns Hopkins y EndCoronavirus.org. RESULTADOS: Las políticas de uso de mascarilla fueron de tipo universal (requerido en tiendas, restaurantes, transporte público), parcial (recomendado, requerido en cualquier lugar público) y ausente. Las asociaciones de la política de uso de mascarilla con casos totales (p = 0.01), casos por millón (p = 0.04) y muertes por millón de habitantes (p = 0.02) resultaron estadísticamente significativas. Las asociaciones de las variables con la tendencia de la curva epidemiológica también resultaron estadísticamente significativas (p = 0.00). CONCLUSIÓN: La recomendación del uso generalizado de mascarilla es una medida con suficiente respaldo científico para reducir el número de contagios y muertes por COVID-19.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II.

The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.

Executive Summary of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management.

The Airway section of the Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) present the Guidelines for the integral management of difficult airway in adult patients. This document provides recommendations based on current scientific evidence, theoretical-educational tools and implementation tools, mainly cognitive aids, applicable to the treatment of the airway in the field of anesthesiology, critical care, emergencies and prehospital medicine. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations and optimization in the progression of the application of strategies to preserve adequate alveolar oxygenation in order to improve safety and quality of care.

Impact of face masks during the treadmill exercise tests. / Impacto del uso de la mascarilla durante la realización de la prueba de esfuerzo en tapiz rodante.

INTRODUCTION AND OBJECTIVE: There is little literature on the use of face masks in a treadmill test (TMT) during the COVID-19 pandemic. The objective of this study is to analyze the impact of face masks during a TMT performed during the prepandemic (without face mask) and postpandemic (with face mask) era. METHODS: Retrospective observational unicentric study of patients undergoing TMT. The inclusion criterion were being over 16years old and having performed at least one TMT in the prepandemic and postpandemic period. RESULTS: One thousand six hundred fifty-five patients were included in the study. Nine hundred thirty-five (56.5%) were men and 720 (43.5%) women. The mean age was 57.3±14.9 and the mean follow-up time was 15.4 months. Fifty-three percent patients had arterial hypertension, 20% dyslipidemia, 12% diabetes mellitus, 8% smoking habit, 19% personal history of ischemic heart disease, 5% COPD, 8% bronchial asthma, and 8% atrial fibrillation. In almost all the variables studied in PE, including the appearance of ventricular arrhythmias, no significant differences were found, neither by age nor sex, except for the existence of a very slight decrease in exercise capacity with mask use in older patients (>65years). CONCLUSIONS: The use of surgical or FFP2 face masks during the TMT did not affect functional capacity, blood pressure, heart rate, or increased ventricular arrhythmias.

Impact of Interface Type on Noninvasive Ventilation Efficacy in Patients With Neuromuscular Disease: A Randomized Cross-Over Trial.

BACKGROUND AND OBJECTIVE: Around 25% of patients with neuro-muscular diseases (NMD) are treated by home noninvasive ventilation (NIV) through an oronasal mask. However, there is growing evidence that nasal masks require lower NIV pressures and result in fewer residual obstructive events. We hypothesized that nasal masks would improve efficacy and reduce side effects compared to oronasal masks in this population. METHODS: open label, cross-over, randomized, study in 2 tertiary care hospitals. Patients with NMD treated by home NIV were randomized for one-week periods to nasal and oronasal interfaces respectively (cross-over). At the end of each period, nocturnal polygraphy (monitoring mouth opening) under NIV, synchronized with transcutaneous partial pressure in CO2 (tcCO2) was performed. Data were collected from the NIV built-in software and NIV side-effects were collected. Intention-to-treat and per protocol analyses were performed. The primary outcome was mean nocturnal SpO2. The secondary outcomes were: percentage of sleep with SpO2<90%, oxygen desaturation index (ODI), mean tcCO2, mean duration of mouth opening during sleep, level of non-intentional leaks and side-effects. RESULTS: Thirty patients with NMD were included. There were no between-group differences for either the primary or secondary outcomes. Post hoc comparisons showed that changing between interfaces reduced NIV efficacy: mean nocturnal SpO2 (p=0.04), ODI (p=0.01), mean tcCO2 (p=0.048), side-effects (p=0.008). CONCLUSION: Nasal masks did not improve NIV efficacy or reduce side effects compared to oronasal masks in patients with NMD treated by home NIV. The efficacy of NIV is reduced during the transition to another interface, requiring close monitoring. Registration number: NCT03458507.

Cardiovascular evaluation using exercise testing performed with face masks during the COVID-19 pandemic.

OBJECTIVE: COVID-19 pandemic is associated with high incidence and fatality, however, non-communicable diseases remain a global public health problem with even greater morbidity and mortality. At present, there is a lag in diagnosis and treatment of patients with heart disease, particularly the performance of exercise testing (ET), due to the fear of aerosol generation and viral dissemination. Although some centers carry out the tests with the use of masks, the information is still superficial and preliminary. The objective of the study was to describe the ergometric performance observed when performing exercise tests during the COVID-19 (PANDEMIC-G) pandemic and to highlight the differences with those results carried out in another time, when there was no COVID-19 (NO PANDEMIC). METHOD: A cross-sectional study was carried out. PANDEMIC-G patients underwent ET between March 2020 and December 2020, once a biological triage was done and all of them wore N95 masks. They were compared to NO PANDEMIC patients that performed an ET between March 2019 and December 2019. Demographic and ergometric variables were presented and analyzed according to their type. All p < 0.05 were considered stochastically significant. RESULTS: A total of 361 ET were studied: 209 (58%) belonged to NO PANDEMIC and 152 (42%) to PANDEMIC-G. The number of ET stopped by dyspnea was greater in PANDEMIC-G (117) than in NO PANDEMIC (8). Exercise tolerance did not show significant changes. Systolic blood pressure, double product, and myocardial oxygen utilization were higher in PANDEMIC-G ET (p < 0.01). CONCLUSIONS: In the COVID-era, fewer stress tests were performed, which were suspended more frequently due to dyspnea. Higher values of systolic blood pressure and myocardial oxygen utilization were observed in PANDEMIC-G as well.

OBJETIVO: La pandemia de COVID-19 se asocia con una alta incidencia y letalidad; sin embargo, las enfermedades no transmisibles siguen siendo un problema de salud pública mundial con una morbilidad y mortalidad aún mayores. Actualmente, existe un retraso en el diagnóstico y tratamiento de los pacientes con enfermedades cardíacas, particularmente en la realización de la prueba de esfuerzo (PE), debido al temor a la generación de aerosoles y la diseminación viral. Aunque algunos centros realizan las pruebas con el uso de tapabocas, la información aún es superficial y preliminar. El objetivo del estudio fue describir el desempeño ergométrico observado al realizar pruebas de ejercicio durante la pandemia COVID-19 (PANDEMIC-G) y remarcar las diferencias con las pruebas realizadas antes de ella (NO PANDEMIC). MÉTODO: Se realizó un estudio transversal. Los pacientes con PANDEMIC-G se sometieron a PE entre marzo y diciembre de 2020, una vez que se realizó un triaje biológico y todos usaron tapabocas N95. Fueron comparados con pacientes NO PANDEMIC, que realizaron una PE entre marzo y diciembre de 2019. Las variables se presentaron y analizaron según su tipo. Todos los valores de p inferiores a 0.05 se consideraron estocásticamente significativos. RESULTADOS: Se estudiaron un total de 361 PE, donde 209 (58%) pertenecían a NO PANDEMIC y 152 (42%) a PANDEMIC-G. El número de PE detenidas por disnea fue mayor en PANDEMIC-G (n = 117) que en NO PANDEMIC (n = 8). La tolerancia al ejercicio no mostró cambios significativos. La presión arterial sistólica, el producto doble y la utilización de oxígeno del miocardio fueron mayores en las PE en el PANDEMIC-G (p < 0.01). CONCLUSIONES: En la era COVID se realizaron menos pruebas de esfuerzo, que se suspendieron con mayor frecuencia por disnea. También se observaron valores más altos de presión arterial sistólica y utilización de oxígeno del miocardio en PANDEMIC-G.

Face masks in the general healthy population. Scientific and ethical issues.

In most European countries, facemasks use is recommended or mandatory in enclosed spaces where physical distancing is not possible. In Spain, this measure was first extended to open public spaces and later made mandatory regardless of whether or not the interpersonal safety distance can be kept. At present, there is no evidence on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2. The mandatory use of masks poses some ethical questions. Firstly, it entails a paternalistic action. Secondly, application of the principle of precaution becomes questionable when there is no clear benefit-risk relationship. Thirdly, compulsoriness can interfere with equity of public health actions. Fourthly, it can result in social stigma and discrimination against those who do not wear one, even though they well may have good reasons for doing so. Lastly, this measure may generate confusion in the population, along with an altered perception of the risk. The World Health Organization recommends its use in public places with a high potential risk of transmission and where other prevention measures, such as physical distancing, are not possible. Mandatory use of masks in public open spaces, regardless of the risk of transmission or of whether or not the interpersonal safety distance can be kept, is an intrusive measure that restricts individual freedoms, and would not appear to be justified on the basis of available scientific evidence. What we need are recommendations explaining where, when, how and what type of mask to wear.

Collateral benefits on other respiratory infections during fighting COVID-19.

PURPOSE: Influenza virus infection is associated with a high disease burden. COVID-19 caused by SARS-CoV-2 has become a pandemic outbreak since January 2020. Taiwan has effectively contained COVID-19 community transmission. We aimed to validate whether fighting COVID-19 could help to control other respiratory infections in Taiwan. METHOD: We collected week-case data of severe influenza, invasive Streptococcus pneumoniae disease and death toll from pneumonia among 25 calendar weeks of the influenza season for four years (2016-2020), which were reported to Taiwan CDC. Trend and slope differences between years were compared. RESULT: A downturn trend of severe influenza, invasive S. pneumoniae disease and the death toll from pneumonia per week in 2019/2020 season and significant trend difference in comparison to previous seasons were noted, especially after initiation of several disease prevention measures to fight potential COVID-19 outbreak in Taiwan. CONCLUSIONS: Fighting COVID-19 achieved collateral benefits on significant reductions of severe influenza burden, invasive S. pneumoniae disease activity, and the death toll from pneumonia reported to CDC in Taiwan.

A Comparative Trial of the Effectiveness of Nasal Interfaces Used to Deliver Continuous Positive Airway Pressure for a Brief Period in Infants With Transient Tachypnea of the Newborn.

INTRODUCTION: There is insufficient data on the effectiveness of the interfaces used for nasal continuous airway pressure (nCPAP) in newborn infants. Transpulmonary pressure (PTP) calculated from a measured esophageal pressure (Pes) could be used as a surrogate for the pressure transmitted to the distal airways during nCPAP. We aimed to compare the effectiveness of two nasal interfaces, the nasal mask and bi-nasal short prongs, during a relatively brief period of respiratory support by calculated PTP (cPTP) in infants with transient tachypnea of the newborn (TTN). METHODS: Newborns with TTN who needed respiratory assistance with nCPAP were randomized to use either bi-nasal short prongs or a nasal mask. Esophageal pressure measurements were done in order to calculate PTP with either interface. The primary outcome was the cPTP transmitted with each nasal interface. Esophageal pressure measurements were recorded and PTP values were calculated from Pes measurements at the 1st, 6th, 12th and 24th hours in each patient as long as the respiratory support lasted. RESULTS: Sixty-two newborns with TTN and on nCPAP were randomized into two groups: Group 1 to use bi-nasal short prongs (n: 31) and Group 2 to use a nasal mask (n: 31). Inspiratory and expiratory Pes and cPTP values at the 1st, 6th, 12th and 24th hours were similar with the two interfaces (P<.05). CONCLUSIONS: A nasal mask is similarly effective and safe as bi-nasal short prongs during a brief period of non-invasive respiratory support with nCPAP in late preterm and term neonates with TTN.

Safety of aerosol therapy in children during noninvasive ventilation with helmet and total face mask.

PURPOSE: To evaluate the consequences of using nebulized drugs in patients subjected to noninvasive ventilation (NIV) with total face mask (TFM) and helmet. DESIGN: A descriptive analytical study of a prospective patient cohort was carried out. AMBIT: Pediatric intensive care unit (PICU) of a tertiary hospital. PATIENTS: Consecutive sampling was used to include all patients admitted to the PICU and requiring NIV with helmet or TFM over a period of 29 months. No patients were excluded. INTERVENTIONS: Nebulized treatment was added according to medical criteria. VARIABLES OF INTEREST: Independent variables were age, sex, diagnosis, disease severity, ventilation parameters and nebulized drugs (if administered). Secondary outcomes were duration and failure of NIV, and length of PICU stay. RESULTS: The most frequent diagnoses were bronchiolitis (60.5%) and asthma (23%). Patients received NIV for a median of 43h. Nebulized drugs were administered in 40% of the cases during NIV, and no adverse effects were registered. Using Bayesian statistics, the calculated probability of suffering an adverse effect was 1.3% with helmet and 0.5% with TFM (high density 95% probability intervals). Patients with helmet and nebulized therapy were in more serious condition than those who did not receive nebulization; nevertheless, no differences were observed regarding the need to change to bilevel modality. With TFM, PICU stay was shorter for the same degree of severity (p=0.033), and the NIV failure rate was higher in patients who did not receive inhaled drugs (p=0.024). CONCLUSIONS: The probability of suffering an adverse effect related to nebulization is extremely low when using a helmet or TFM. Inhaled therapy with TFM may shorten PICU stay in some patients.

Reasons for the use of masks in open areas after the Peruvian government announced that it will no longer be mandatory in the context of COVID-19 in 2022

Introduction: In Peru, a high proportion of fully immunized people against COVID-19 has been achieved, which has mitigated the severity of the disease. Thus, under the recommendation of experts, the Peruvian government issued Supreme Decree 118-2022-PCM, which indicated that the use of masks is optional in open and ventilated enclosed spaces as of October 1, 2022. Objective: The aim of the present study was to find out the reasons why people continued to wear masks even though it was not mandatory in outdoor environments. Methods: A total of 335 people participated, with an average age of 26.11 years (73.1% women). A data collection form was prepared where sociodemographic and health information was requested; in addition, the question "Why do you continue to wear mask despite it being optional in open and closed ventilated spaces?" was included. The data obtained from the last open question of the instrument was analyzed by means of a discursive textual analysis (DTA) and an exploratory analysis through IRAMUTEQ. Results: Results indicate that people continue to wear masks, despite the lifting of the restrictions, to avoid contagion of COVID-19 and other respiratory diseases. In addition, the prevention of possible infection and transmission of the virus also focused on the family and vulnerable people. Discussion: It is concluded that the practice of wearing masks may be influenced by individual perceptions of risk and interpretations of responsibility and solidarity towards others.

Introducción: En el Perú, se logró una alta proporción de personas completamente inmunizados contra COVID-19 que ha mitigado la severidad de la enfermedad. Es así que, bajo la recomendación de expertos el gobierno peruano emitió el Decreto Supremo 118-2022-PCM, donde se indicó que el uso de la mascarilla es opcional en espacios abiertos y espacios cerrados ventilados a partir del 1 de octubre del 2022. Objetivo: El presente estudio fue conocer las razones por las cuales las personas continuaron usando mascarilla a pesar de que no era obligatorio en ambientes exteriores. Metodología: Participaron un total de 335 personas con un promedio de edad de 26.11 años (73.1% mujeres). Se elaboró una ficha de recolección de datos donde se solicitó información sociodemográfica y de salud; además, se incluyó la pregunta "¿por qué sigue utilizando la mascarilla a pesar de que es opcional en espacios abiertos y cerrados ventilados?" Los datos obtenidos de la última pregunta abierta del instrumento se analizaron mediante un análisis textual discursivo (ATD) y un análisis exploratorio a través de IRAMUTEQ. Resultados: Los resultados indicaron que, las personas seguían utilizando mascarillas, a pesar de estar levantadas las restricciones, para evitar contagios de la COVID-19 y de otras enfermedades respiratorias. Además, esta prevención de una posible infección y transmisión del virus es enfocada también a la propia familia y personas vulnerables. Discusión: Se concluye que, la práctica de usar mascarillas puede estar influenciada por las percepciones individuales del riesgo y las interpretaciones de responsabilidad y solidaridad frente a los demás.

Air-Q® versus LMA Fastrach™ for fiberoptic-guided intubation: A randomized cross-over manikin trial. / Estudio aleatorizado cruzado para evaluar la intubación guiada con fibrobroncoscopio a través del dispositivo Air-Q® versus la mascarilla laríngea Fastrach™ en maniquís.

INTRODUCTION: Airway management is still a major cause of anesthesia-associated morbidity and mortality. Supraglottic devices are recommended in difficult airway management guidelines. The aim of this study was to compare the performance of the Air-Q® and the LMA Fastrach™ for fiberoptic guided tracheal intubation. METHODS: Thirty-three anesthesia trainees participated in this randomized crossover study. Time to insert the dedicated airways (insertion of the airway into the manikin and delivery of two breaths), time to tracheal intubation (fiberoptic-guided tracheal intubation), time to remove the dedicated airway (removal of the Air-Q®/LMA Fastrach™ over the tracheal tube) and the opinion of the ease of use of the anesthesia trainees were measured. RESULTS: There was 100% success rate for tracheal intubation with both devices on the first attempt. Time to insert the dedicated device and deliver two breaths was 10±3s for the Air-Q® and 11±3s for the LMA Fastrach™, P=.07. Time taken to intubate the trachea was shorter with the air-Q®, 38±15 s, than with the LMA Fastrach™, 47±19s, P=.017. Overall procedure time was significantly shorter with the Air-Q® as compared with the LMA Fastrach™, with a mean time of 74±21s and 87±28s respectively, P=.002. Air-Q® removal was considered easier than LMA Fastrach™ removal, P=.005. There were no tube dislodgements during the removal of the dedicated airways. CONCLUSIONS: Inexperienced anesthesia residents can perform fiberoptic-guided intubation through Air-Q® and LMA Fastrach™ in a clinically acceptable time with high success.

Cuestionario de percepción de factores causales de la Covid-19 (CPFC-Covid-19) / [Questionnaire on the perception of causal factors of Covid-19 (CPFC-Covid-19)]

En el artículo se detalla el procedimiento de validación de un cuestionario que analiza la percepción de los factores causales de la pandemia de la COVID-19, el CPFC-COVID-19. Se realizó una prueba piloto con 55 sujetos, se analizó la validez de contenido y de comprensión a través del juicio de 8 expertos y la validez de constructo a través de un análisis factorial exploratorio. Además, se realizó un análisis factorial confirmatorio con una muestra de 427 personas, se calculó la validez convergente y se hizo un análisis descriptivo y de consistencia interna de los factores del cuestionario final. El CPFC-COVID-19 quedó constituido por 20 ítems y cuatro dimensiones: Distanciamiento social y Protección (DSP), Impacto psicológico percibido (IPP), Escepticismo (E) y Credibilidad de la información percibida (CIP). Los resultados demuestran la validez del cuestionario y unos altos índices de fiabilidad, lo que permite conocer las percepciones de la población acerca de los factores causales de la COVID-19.

The article details the validation procedure for a questionnaire that analyzes the perception of the causal factors of the COVID-19 pandemic, the CFPQ-COVID- 19. A pilot test was carried out with 55 subjects, its content and comprehension validity was analyzed through the judgment of 8 experts, and its construct validity through an exploratory factor analysis. In addition, a confirmatory factorial analysis was carried out with a sample of 427 people, the convergent validity was calculated, and a descriptive and internal consistency analysis of the factors of the final questionnaire was performed. The CPFC-COVID-19 finally comprised 20 items and four dimensions: Social distancing and Protection (SDP), Perceived psychological impact (PPI), Skepticism (S) and Credibility of perceived information (CPI). The results demonstrated the validity of the questionnaire and high reliability rates, which allows us to determine the perceptions of the population about the causal factors of COVID-19.

Uso de mascarillas faciales y frecuencia cardiaca en adultos de 18 a 60 años / Use of face masks and heart rate in adults aged 18 to 60 years / Uso de máscara facial e freqüência cardíaca em adultos de 18-60 anos de idade

Objetivo. Evaluar la influencia del uso de mascarillas faciales sobre la frecuencia cardiaca (FC) en reposo y en la actividad física en adultos de 18 a 60 años, en la ciudad de Lima, durante la pandemia por la COVID-19 en el 2020. Métodos. Se realizó un estudio de tipo experimental, analítico, prospectivo y transversal. Para la recopilación de datos se realizó una encuesta virtual vía Google forms, con una serie de preguntas e indicaciones para la correcta medida de la FC en diferentes situaciones: reposo, inmediatamente posterior a la actividad y 5 min posterior a la actividad física con y sin el uso de mascarillas (KN95, tela, quirúrgica y N95). Para el presente estudio se analizaron las posibles causas del aumento de la FC, por lo que fueron elegidos 60 adultos asintomáticos, 40 mujeres y 20 hombres, en el rango de edades entre 18 hasta 60 años. Resultados. Se obtuvo que la diferencia de la FC promedio con y sin uso de mascarilla inmediatamente posterior a la actividad física aumentó signifcativamente dependiendo del tipo de mascarilla. Con respecto a la KN95, se presenció un aumento de hasta en 9,6 latidos/min, mientras las mascarillas en tela, quirúrgica y N95 mostraron un aumento de 5,9, 5,6 y 7,4 latidos/min, respectivamente, bajo las mismas condiciones, calculándose en una media de 112,7 latidos/min por sobre 10,6 latidos/min en reposo, evidenciándose un incremento en hasta 7 % de su valor en reposo. Conclusión. Se comprobó que el uso de la mascarilla ejerce una notable influencia en la FC, inmediatamente y 5 minutos posterior terminada la actividad física, siendo la KN95 la mascarilla facial más utilizada y la de mayor influencia en el pulso cardiaco

Objective. To evaluate the influence of the use of face masks on resting heart rate (HR) and physical activity in adults aged 18 to 60 years, in the city of Lima, during the COVID-19 pandemic in 2020. Methods. An experimental, analytical, prospective and cross-sectional study was carried out. For data collection, a virtual survey was carried out via Google Forms, with a series of questions and indications for the correct measurement of HR in different situations: at rest, immediately after activity and 5 min after physical activity with and without the use of masks (KN95, fabric, surgical and N95). For the present study, the possible causes of increased HR were analyzed, so 60 asymptomatic adults, 40 women and 20 men, in the age range of 18 to 60 years, were selected. Results. It was found that the difference in mean HR with and without mask use immediately after physical activity increased signifcantly depending on the type of mask. With respect to the KN95, an increase of up to 9.6 beats/min was observed, while the fabric, surgical and N95 masks showed an increase of 5.9, 5.6 and 7.4 beats/min, respectively, under the same conditions, calculating an average of 112.7 beats/ min over 10.6 beats/min at rest, showing an increase of up to 7% of its value at rest. Results. It was obtained that the difference in the average HR with and without mask use immediately after physical activity increased signifcantly depending on the type of mask. With respect to KN95, an increase of up to 9,6 beats/min was observed, while cloth, surgical and N95 masks showed an increase of 5,9, 5,6 and 7,4 beats/min, respectively, under the same conditions, calculated at an average of 112.7 beats/min over 10,6 beats/min at rest, evidencing an increase in up to 7 % of their value at rest. Conclusion. It was found that the use of the face mask exerts a notable influence on HR, immediately and 5 minutes after the end of the physical activity, being the KN95 the most used face mask and the one with the greatest influence on the cardiac pulse.

Objetivo. Avaliar o influence do uso de máscaras faciais em repouso de freqüência cardíaca (FC) e atividade física em adultos de 18-60 anos de idade, na cidade de Lima, durante a pandemia da COVID-19 em 2020. Métodos. Foi realizado um estudo experimental, analítico, prospectivo e de corte transversal. Para a coleta de dados, foi realizada uma pesquisa virtual através de formulários Google, com uma série de perguntas e indicações para a medição correta de RH em diferentes situações: em repouso, imediatamente após o repouso, imediatamente após o exercício, e imediatamente após o exercício. situações: em repouso, imediatamente após a atividade e 5 minutos após a atividade física com e sem o uso de máscaras (KN95, tecido, cirúrgico e N95). Para o presente estudo, foram analisadas as possíveis causas do aumento do RH e foram selecionados 60 adultos assintomáticos, 40 mulheres e 20 homens, na faixa etária de 18 a 60 anos. Resultados. Descobriu-se que a diferença em HR com e sem o uso da máscara imediatamente após a atividade física aumentou significativamente, dependendo do tipo de máscara. Com respeito ao KN95, foi testemunhado um aumento de até 9,6 batidas/min, enquanto o tecido, as máscaras cirúrgicas e N95 mostraram um aumento de 5,9, 5,6 e 7,4 batimentos/min, respectivamente, nas mesmas condições, com uma média de 112,7 batimentos/min acima de 10,6 batimentos/min em repouso, mostrando um aumento de até 7% de seu valor de repouso. Conclusão. Verificou-se que o uso da máscara facial exerce uma influência notável na FC, imediatamente e 5 minutos após o final da atividade física, sendo a KN95 a máscara facial mais usada e a que tem maior influência no pulso cardíaco.

Condición psicofisiológica en el desempeño de tareas sanitario-militares con mascarilla quirúrgica / Psychophysiological Condition in the Performance of Sanitary-Military Tasks with Surgical Mask

Se ha analizado, mediante un diseño cuasi-experimental con 19 sanitarios (33.7 ± 5.1 años), la importancia de la condición física, cognitiva y el rendimiento al portar un equipo de protección con mascarilla quirúrgica durante situaciones de entrenamiento en contextos significativos de intervención militar. Se midieron la frecuencia cardíaca y su variabilidad, los niveles de glucosa, la termorregulación, la fuerza explosiva y el esfuerzo percibido en tareas de rendimiento motor específicas (tapping test, torniquete, municionamiento), y de rendimiento cognitivo y decisional (triaje). Los resultados indican diferencias significativas (p < 05) en función de la condición física (glucemia y fuerza explosiva), del género (fuerza explosiva y torniquete), del hábito tabáquico (esfuerzo percibido) y del cuerpo de pertenencia (nivel de glucemia) en el grupo de estudio. Como conclusión, se destaca la importancia del entrenamiento físico y psicológico para la mejora de la respuesta operativa en situaciones sanitario-militares que requieren el uso de mascarilla quirúrgica. (AU)

Using a quasi-experimental design with 19 health workers (33.7 ± 5.1 years), the importance of physical and cognitive condition and performance when wearing protective equipment with a surgical mask during training situations in significant contexts of military intervention has been analysed. Heart rate and its variability, glucose levels, thermoregulation, explosive strength and perceived effort in specific motor performance tasks (tapping test, tourniquet, ammunition), and cognitive and decisional performance (triage) were measured. The results indicate significant differences (p < 05) depending on the physical condition (blood glucose and explosive strength), gender (explosive strength and tourniquet), smoking habit (perceived effort) and specialty (glucose level) in the study group. In conclusion, the importance of physical and psychological training is highlighted to improve the operational response in health-military situations that require the use of a surgical mask. (AU)

Intubación orotraqueal a través de mascarilla laríngea Ambu AuraOnceTM en paciente con lesión de médula espinal cervical / Orotracheal intubation through Ambu AuraOnceTM laryngeal mask in patient with cervical spinal cord injury

Resumen: Reportamos el manejo exitoso de la vía aérea con intubación orotraqueal a través de una máscara laríngea AuraOnceTM en un paciente con lesión de la médula espinal cervical. Su uso fue como dispositivo de rescate de la vía aérea tras intubación orotraqueal fallida con laringoscopía directa y dificultad para la ventilación con mascarilla en una paciente traumatizada de 46 años. Se tomó la decisión de utilizar la mascarilla laríngea sin intubación como conducto para la colocación de un tubo orotraqueal, lo cual se realizó con éxito. Este uso alternativo de la mascarilla laríngea Ambu AuraOnce podría ser de gran valor para los trabajadores de la salud en países de escasos recursos donde los dispositivos avanzados para las vías respiratorias no están fácilmente disponibles.

Abstract: We reported a successful airway management in a patient with a diagnosed cervical spinal injury with a non-intubating laryngeal mask AuraOnceTM. Its use was as a rescue airway device after failed orotracheal intubation with direct laryngoscopy and difficulty with facemask ventilation in a 46-year-old trauma patient. The decision was made to use the non-intubating laryngeal mask as a conduit for the placement of an orotracheal tube, which was done successfully. This alternative use of the Ambu AuraOnce laryngeal mask could be of great value to healthcare workers in resource-poor countries where advanced airway devices are not readily available.