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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 366-367

T-piece for COVID-19 patients: Innovation in a time of crisis


1 Department of Anaesthesiology, AIIMS, Patna, Bihar, India
2 Department of Trauma and Emergency, AIIMS, Patna, Bihar, India

Date of Submission13-Jun-2021
Date of Decision13-Jun-2021
Date of Acceptance31-Jul-2021
Date of Web Publication13-Sep-2021

Correspondence Address:
Dr. Abhyuday Kumar
Room no. 15, Department of Anaesthesiology, AIIMS, Phulwari Sharif, Patna - 801 507, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijrc.ijrc_74_21

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How to cite this article:
Kumar R, Kumar A, Kumar N, Kumar A, Kumar A. T-piece for COVID-19 patients: Innovation in a time of crisis. Indian J Respir Care 2021;10:366-7

How to cite this URL:
Kumar R, Kumar A, Kumar N, Kumar A, Kumar A. T-piece for COVID-19 patients: Innovation in a time of crisis. Indian J Respir Care [serial online] 2021 [cited 2021 Oct 26];10:366-7. Available from: http://www.ijrc.in/text.asp?2021/10/3/366/325889



Sir,

Coronavirus disease 19 (COVID-19) is caused by a highly contagious virus (SARS-CoV-2) and is spread from person to person via droplets, contact, and aerosolized particles.[1] Health care workers (HCWs) involved in the care of intubated and tracheostomised patients are at increased risk due to aerosolization. There are many conditions that increase the risk of transmission of this infection to HCW such as inadequate hand hygiene and personal protective equipment, prolonged exposure, insufficient spacing, and rooms without negative pressure, etc. T-piece is an important and frequently used device in intensive care units for oxygen therapy or Spontaneous breathing trials (SBTs). As it has an open end, there is a chance of dispersion of aerosols during exhalation. SARS-CoV-2 remained viable in aerosols for the duration of 3 h, with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. Aerosols from infected persons may therefore pose an inhalation threat even at considerable distances and in enclosed spaces.[2]

To overcome this problem, we modified a T-piece using parts of a nonrebreathing oxygen mask with reservoir bag [Figure 1]a. In the modified T-piece, an inspiratory valve was assembled at one end and an extra port was created close to it for the oxygen inlet [Figure 1]b. An expiratory valve was assembled at the end of reservoir tubing where a reservoir bag was attached. Suction port was used for end-tidal CO2 (EtCO2) monitoring with the use of pressure monitoring line. Aerodynamics of the device is such that along with oxygen there will be entrainment of air through the one-way inspiratory valve during inspiration. However, air will not come in from the reservoir bag due to the presence of one-way expiratory valve. During expiration, the expiratory valve will open and the inspiratory valve will be closed, expelling the air and aerosols to the reservoir bag, which will then be suctioned out. Some of the advantages of this device are:
Figure 1: (a) Parts of the T-piece assembly. (b) Aerodynamics of the modified T-piece assembly

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  1. Prevent aerosol dispersion during oxygen therapy or SBT of COVID-19 patients
  2. Prevent aerosol dispersion during nebulization
  3. Assembly is easy to make from readily available materials in the hospital setting
  4. Advantage of EtCO2 monitoring.


We acknowledge that the device is not tested for its effectiveness in preventing the infection. This device is a prototype intended to be used during this tide of COVID-19 pandemic where the world is in search of new techniques to counter this virus. However, a better device based on these principles can be engineered in future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations. Available from: https://www.who.int/publications-detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations. [Last accessed on 2020 May 29].  Back to cited text no. 1
    
2.
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020;382:1564-7.  Back to cited text no. 2
    


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