Letter to the Editor
Wearing of medical mask over the high-flow nasal cannula for safer oxygen therapy in the COVID-19 era
S. Hamadaa, N. Tanabeb,
, H. Inouec, T. Hiraib
Corresponding author
ntana@kuhp.kyoto-u.ac.jp
Corresponding author at: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Corresponding author at: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
a Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan
b Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
c Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan
Read
11847
Timeswas read the article
3029
Total PDF
8818
Total HTML
Share statistics
array:24 [ "pii" => "S2531043720302269" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.10.009" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1556" "copyright" => "Sociedade Portuguesa de Pneumologia" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2021;27:171-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2531043720302087" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.08.008" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1541" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2021;27:173-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "COVID-19 does not stop good practice in smoking cessation: Safe use of CO analyzer for smokers in the Covid era" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "173" "paginaFinal" => "174" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1752 "Ancho" => 1500 "Tamanyo" => 133782 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Smokerlyzer’s components: electronic device (a); original fitting (b); disposable mouthpieces (c); fitting specially created (d); disposable spirometry mouthpieces (e).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Munarini, C. Veronese, A.C. Ogliari, F. Allegri, M.G. Bolchi, R. Boffi" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Munarini" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Veronese" ] 2 => array:2 [ "nombre" => "A.C." "apellidos" => "Ogliari" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Allegri" ] 4 => array:2 [ "nombre" => "M.G." "apellidos" => "Bolchi" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Boffi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720302087?idApp=UINPBA00004E" "url" => "/25310437/0000002700000002/v2_202105110755/S2531043720302087/v2_202105110755/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S253104372030252X" "issn" => "25310437" "doi" => "10.1016/j.pulmoe.2020.10.015" "estado" => "S300" "fechaPublicacion" => "2021-03-01" "aid" => "1567" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Pulmonol. 2021;27:167-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Effects of prone and lateral position in non-intubated patients with 2019 Novel Coronavirus (COVID-19) pneumonia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "167" "paginaFinal" => "171" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 859 "Ancho" => 2175 "Tamanyo" => 164611 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pulse oximetry pleth waveform of the same patient during supine and prone position.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G Schifino, A.J. de Grauw, F Daniele, V Comellini, L Fasano, L Pisani" "autores" => array:6 [ 0 => array:2 [ "nombre" => "G" "apellidos" => "Schifino" ] 1 => array:2 [ "nombre" => "A.J." "apellidos" => "de Grauw" ] 2 => array:2 [ "nombre" => "F" "apellidos" => "Daniele" ] 3 => array:2 [ "nombre" => "V" "apellidos" => "Comellini" ] 4 => array:2 [ "nombre" => "L" "apellidos" => "Fasano" ] 5 => array:2 [ "nombre" => "L" "apellidos" => "Pisani" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S253104372030252X?idApp=UINPBA00004E" "url" => "/25310437/0000002700000002/v2_202105110755/S253104372030252X/v2_202105110755/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Wearing of medical mask over the high-flow nasal cannula for safer oxygen therapy in the COVID-19 era" "tieneTextoCompleto" => true "saludo" => "To the Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "171" "paginaFinal" => "173" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Hamada, N. Tanabe, H. Inoue, T. Hirai" "autores" => array:4 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Hamada" "email" => array:1 [ 0 => "sh1124@kuhp.kyoto-u.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "N." "apellidos" => "Tanabe" "email" => array:1 [ 0 => "ntana@kuhp.kyoto-u.ac.jp" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:4 [ "nombre" => "H." "apellidos" => "Inoue" "email" => array:1 [ 0 => "hiyumi2001@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "T." "apellidos" => "Hirai" "email" => array:1 [ 0 => "t_hirai@kuhp.kyoto-u.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, Japan" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 1500 "Tamanyo" => 224994 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photographs of droplet dispersion after cough when not utilizing (A) and utilizing supplemental oxygen via nasal cannula (B) and HFNC (C) and with an appropriately placed medical mask when not utilizing (D) and utilizing supplemental oxygen delivered by nasal cannula (E) and HFNC (F).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">HFNC = high-flow nasal cannula.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The emergence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and its associated respiratory disease, coronavirus disease 2019 (COVID-19), has imposed social and medical burdens worldwide. Up to 12% of patients with SARS-CoV-2 infection required intensive care unit admission. Among them, 60-70% had acute hypoxic respiratory failure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">High-flow nasal cannula (HFNC) oxygen therapy is the generally prescribed respiratory therapy for acute hypoxic respiratory failure. This therapy might help limit the need for invasive mechanical ventilation (IMV) and prevent the occurrence of associated adverse events such as ventilator-associated pneumonia in COVID-19 patients.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, administration of HFNC oxygen therapy in COVID-19 patients remains controversial, owing to uncertainties regarding the potential risk of viral transmission to healthcare workers, as this therapy is considered as an aerosol-generating procedure.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Indeed, IMV can be selected when low-flow oxygen therapy through a nasal canula fails and a shortage of ventilators is a medical and social problem in regions particularly hard-hit by this pandemic. Therefore, a safe and effective respiratory management for COVID-19 patients should be urgently established.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent practical recommendations for COVID-19 patients indicate the use of a medical mask over the HFNC device to limit particle dispersion due to exhaled gas flow.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> These recommendations are partially supported by two previous experimental studies that indirectly examined exhaled breath by visualizing airflow movement using smoke<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and computational fluid dynamic (CFD) simulation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> However, to the best of our knowledge, there is no direct evidence that this strategy could reduce the risk of SARS-CoV-2 transmission to healthcare workers in clinical settings due to the technical difficulty in direct visualization of particle dispersion. Here we present an experimental trial with a novel fine particle visualization system, which allowed evaluating whether particle dispersion from coughing while on HFNC oxygen could be suppressed by an appropriately placed medical mask.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We ran six scenarios with a healthy volunteer with nasal cannula at 3 L/min and 21% fraction of inspired oxygen (room air) delivered at 40 L/min 37℃ via HFNC (AIRVO™ 2 device with an Optiflow™ nasal interface [Fisher & Paykel, Auckland, New Zealand]). The volunteer was in a sitting position (seat height: 45 cm), and the evaluation was performed with and without wearing a standard medical mask. Particle dispersion was visualized by a video camera set at 29.97 frames per second (Eye Scope). This system used a light emitting diode (wavelength 400-410 nm; Parallel Eye D), which permitted a visualization of particle ≥1 μm in diameter. Images obtained were reconstructed as videos using commercial software (Particle Eye). Equipment described above depended on Shin Nippon Air Technologies (Tokyo, Japan).</p><p id="par0025" class="elsevierStylePara elsevierViewall">First, we identified exhaled particles dispersed from coughing in the absence of either nasal cannula, HFNC, or a mask, which reached a horizontal distance of 57 cm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and supplemental video A). Second, exhaled particles were dispersed from coughing in a similar fashion when using nasal cannula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and supplemental video B) and HFNC (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and supplemental video C), which reached a horizontal distance of 62 cm and 59 cm, respectively. Notably, when the volunteer wore a standard medical mask, no exhaled particles were detected from coughing either without (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D and supplemental video D) or with concurrent nasal cannula (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>E and supplemental video E) or HFNC therapy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>F and supplemental video F).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">This report substantially increases our understanding on the droplet dispersion risk during HFNC therapy. Wearing a medical mask over HFNC device almost completely suppressed particle dispersion induced by coughing. Our findings are first direct evidence that wearing a medical mask will be a useful manner in administering HFNC oxygen therapy and strongly support the recommendation as described above. Moreover, the present direct visualization of the suppressive effect of the medical mask <span class="elsevierStyleItalic">in vivo</span> further extends a previous CFD simulation by Leonard et al. who showed that the hypothetical medical mask captured 83.2% of particles (0.1-100 μm) during high-velocity nasal insufflation at 40 L/min.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite the advanced technology, we and Leonard et al. could not visualize or simulate particles of <0.1 μm. Whether these small particles (aerosols) could be sources of transmission of SARS-CoV-2, remains unclear. Further studies are needed to evaluate whether HFNC oxygen therapy could increase risk of SARS-CoV-2 transmission to healthcare workers and whether wearing a medical mask under HFNC oxygen therapy could reduce this risk in clinical settings.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The visual evidence presented here should be shared with all care-givers wearing personal protective equipment to encourage the use of HFNC oxygen therapy for managing hypoxic COVID-19 patients. Hopefully, this method helps overcome this disastrous pandemic situation worldwide.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">Satoshi Hamada reports grants from Teijin Pharma, outside the submitted work.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Financial conflicts</span><p id="par0050" class="elsevierStylePara elsevierViewall">This study was funded in part by the <span class="elsevierStyleGrantSponsor" id="gs0005">JSPS KAKENHI</span><span class="elsevierStyleGrantNumber" refid="gs0005">19K17634</span> (SH).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The Department of Advanced Medicine for Respiratory Failure is a Department of Collaborative Research Laboratory funded by Teijin Pharma.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "xpalclavsec1369292" "titulo" => "Abbreviations" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial conflicts" ] 3 => array:2 [ "identificador" => "xack529735" "titulo" => "Acknowledgements" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-07-28" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec1369292" "palabras" => array:5 [ 0 => "CFD" 1 => "COVID-19" 2 => "HFNC" 3 => "IMV" 4 => "SARS-CoV-2" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia><elsevierMultimedia ident="upi0020"></elsevierMultimedia><elsevierMultimedia ident="upi0025"></elsevierMultimedia><elsevierMultimedia ident="upi0030"></elsevierMultimedia><elsevierMultimedia ident="upi0035"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0020" ] ] ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 737 "Ancho" => 1500 "Tamanyo" => 224994 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Photographs of droplet dispersion after cough when not utilizing (A) and utilizing supplemental oxygen via nasal cannula (B) and HFNC (C) and with an appropriately placed medical mask when not utilizing (D) and utilizing supplemental oxygen delivered by nasal cannula (E) and HFNC (F).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">HFNC = high-flow nasal cannula.</p>" ] ] 1 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 15622 ] ] 2 => array:5 [ "identificador" => "upi0010" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc2.mp4" "ficheroTamanyo" => 5372582 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc2.flv" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc2.m4v" "poster" => "mmc2.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 3 => array:5 [ "identificador" => "upi0015" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc3.mp4" "ficheroTamanyo" => 4123381 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc3.flv" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc3.m4v" "poster" => "mmc3.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 4 => array:5 [ "identificador" => "upi0020" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc4.mp4" "ficheroTamanyo" => 3265053 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc4.flv" "poster" => "mmc4.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc4.m4v" "poster" => "mmc4.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 5 => array:5 [ "identificador" => "upi0025" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc5.mp4" "ficheroTamanyo" => 3448923 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc5.flv" "poster" => "mmc5.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc5.m4v" "poster" => "mmc5.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 6 => array:5 [ "identificador" => "upi0030" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc6.mp4" "ficheroTamanyo" => 3507402 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc6.flv" "poster" => "mmc6.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc6.m4v" "poster" => "mmc6.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] 7 => array:5 [ "identificador" => "upi0035" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc7.mp4" "ficheroTamanyo" => 3507402 "Video" => array:2 [ "flv" => array:5 [ "fichero" => "mmc7.flv" "poster" => "mmc7.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "mp4" => array:5 [ "fichero" => "mmc7.m4v" "poster" => "mmc7.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Phua" 1 => "L. Weng" 2 => "L. Ling" 3 => "M. Egi" 4 => "C.M. Lim" 5 => "J.V. Divatia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-2600(20)30161-2" "Revista" => array:7 [ "tituloSerie" => "Lancet Respir Med" "fecha" => "2020" "volumen" => "8" "paginaInicial" => "506" "paginaFinal" => "517" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32272080" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1386505616302258" "estado" => "S300" "issn" => "13865056" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: Systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Agarwal" 1 => "J. Basmaji" 2 => "F. Muttalib" 3 => "D. Granton" 4 => "D. Chaudhuri" 5 => "D. Chetan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12630-020-01740-2" "Revista" => array:6 [ "tituloSerie" => "Can J Anaesth" "fecha" => "2020" "volumen" => "67" "paginaInicial" => "1217" "paginaFinal" => "1248" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32542464" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus statement: safe airway society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Dj Brewster" 1 => "N. Chrimes" 2 => "Tb Do" 3 => "K. Fraser" 4 => "Cj Groombridge" 5 => "A. Higgs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5694/mja2.50598" "Revista" => array:6 [ "tituloSerie" => "Med J Aust" "fecha" => "2020" "volumen" => "212" "paginaInicial" => "472" "paginaFinal" => "481" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32356900" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Respiratory care committee of Chinese Thoracic Society [Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia] [article in Chinese]" ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3760/cma.j.issn.1001-0939.2020.0020" "Revista" => array:5 [ "tituloSerie" => "Zhonghua Jie He He Hu Xi Za Zhi" "fecha" => "2020" "volumen" => "17" "paginaInicial" => "E020" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32077661" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Protecting healthcare workers from SARS-CoV-2 infection: practical indications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Ferioli" 1 => "C. Cisternino" 2 => "V. Leo" 3 => "L. Pisani" 4 => "P. Palange" 5 => "S. Nava" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Eur Respir Rev" "fecha" => "2020" "volumen" => "29" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.S. Hui" 1 => "B.K. Chow" 2 => "T. Lo" 3 => "O.T.Y. Tsang" 4 => "F.W. Ko" 5 => "S.S. Ng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01184-2018" "Revista" => array:4 [ "tituloSerie" => "Eur Respir J" "fecha" => "2019" "volumen" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30705126" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preliminary findings on control of dispersion of aerosols and droplets during high-velocity nasal insufflation therapy using a simple surgical mask: implications for the high-flow nasal cannula" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Leonard" 1 => "C.W. Atwood Jr" 2 => "B.K. Walsh" 3 => "R.J. DeBellis" 4 => "G.C. Dungan" 5 => "W. Strasser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.chest.2020.03.043" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2020" "volumen" => "158" "paginaInicial" => "1046" "paginaFinal" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32247712" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack529735" "titulo" => "Acknowledgements" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">The authors are grateful to Mr. Ryuta Okamoto, Mr. Taro Furukawa, and Mr. Kozo Takahashi, who are members of Shin Nippon Air Technologies, for technical assistance.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/25310437/0000002700000002/v2_202105110755/S2531043720302269/v2_202105110755/en/main.assets" "Apartado" => array:4 [ "identificador" => "72880" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25310437/0000002700000002/v2_202105110755/S2531043720302269/v2_202105110755/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043720302269?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 29 | 5 | 34 |
| 2024 October | 140 | 54 | 194 |
| 2024 September | 118 | 54 | 172 |
| 2024 August | 131 | 51 | 182 |
| 2024 July | 173 | 45 | 218 |
| 2024 June | 90 | 25 | 115 |
| 2024 May | 91 | 45 | 136 |
| 2024 April | 100 | 45 | 145 |
| 2024 March | 113 | 31 | 144 |
| 2024 February | 60 | 26 | 86 |
| 2024 January | 104 | 31 | 135 |
| 2023 December | 60 | 27 | 87 |
| 2023 November | 104 | 57 | 161 |
| 2023 October | 76 | 42 | 118 |
| 2023 September | 93 | 36 | 129 |
| 2023 August | 72 | 17 | 89 |
| 2023 July | 82 | 31 | 113 |
| 2023 June | 72 | 20 | 92 |
| 2023 May | 98 | 30 | 128 |
| 2023 April | 65 | 24 | 89 |
| 2023 March | 95 | 32 | 127 |
| 2023 February | 74 | 33 | 107 |
| 2023 January | 68 | 26 | 94 |
| 2022 December | 95 | 32 | 127 |
| 2022 November | 91 | 45 | 136 |
| 2022 October | 110 | 55 | 165 |
| 2022 September | 71 | 48 | 119 |
| 2022 August | 84 | 49 | 133 |
| 2022 July | 109 | 63 | 172 |
| 2022 June | 110 | 39 | 149 |
| 2022 May | 98 | 51 | 149 |
| 2022 April | 86 | 49 | 135 |
| 2022 March | 117 | 74 | 191 |
| 2022 February | 100 | 57 | 157 |
| 2022 January | 165 | 64 | 229 |
| 2021 December | 138 | 64 | 202 |
| 2021 November | 107 | 43 | 150 |
| 2021 October | 103 | 76 | 179 |
| 2021 September | 128 | 65 | 193 |
| 2021 August | 157 | 68 | 225 |
| 2021 July | 184 | 50 | 234 |
| 2021 June | 216 | 105 | 321 |
| 2021 May | 689 | 434 | 1123 |
| 2021 April | 1744 | 315 | 2059 |
| 2021 March | 758 | 138 | 896 |
| 2021 February | 532 | 116 | 648 |
| 2021 January | 534 | 93 | 627 |
| 2020 December | 184 | 49 | 233 |
Show all
