Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic

Abstract

At the end of 2019, several cases of pneumonia were identified in Wuhan (Hubei, China) [1], caused by a new Orthocoronavirinae, commonly known as coronavirus, fromthe Coronaviridae family. In January 2020, there was a public health emergency declaration [2] and, as of March 2020, a pandemic [3,4]. At present, more than 2 million cases have been confirmed globally (2.160.2017 April 18th) [5-9]. In Spain, the first spots of epidemiological interestwere identified in Madrid. Some of them were registered in the sanitary region where both Hospital Universitario Infanta Leonor and Virgen de la Torre Hospitals belong. The first PCR-positive patient was detected on March 4th. After two weeks, on 18th March, the number of positive cases increased to 302, and 41 patients died. By 1st April, one month after the outbreak, the total number of caseswas 1714. These data confirmed the explosive progression of the pandemic and the high mortality of patients who were hospitalized and made it necessary to implement several and different therapeutic measures to try and revert the catastrophic progression of this infection. The most extended therapeutic approach for COVID-19 is based on two main strategies [10-13]: pharmacological treatment directed toward several physiological targets (viremia, immunological reactions, prothrombotic reactions) and hemodynamic and respiratory support with positive end-expiratory pressure (PEEP) in addition to mechanical ventilation. This is vitally necessary until pharmacological treatment or patient immune responses become effective. China and Italy have already described that acute respiratory distress syndrome. (ARDS) is the most common manifestation in the clinical course of COVID-19 pneumonia [11-14]; however, this syndrome has a different progression than other respiratory diseases. The first-choice treatment for ARDS is mechanical ventilation (MV) with the use of orotracheal intubation (OTI). The ARDSmortality rate is over 50%, and the delay in this procedure is related to an even worse prognosis [15,16]. The main limiting factors that healthcare systems must face when handling these critical patients are the limited access to ventilators and ICU resources and the fact that they are already overwhelmed by massive hospitalization due to respiratory distress and OTI needs [17,18]. This is why current lines of work are focused on developing respiratory support alternatives that will gain time or allow the maintenance of an acceptable respiratory status until patients can access the ICU [19,20]. In the absence of approvedmechanical devices, such as continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP) devices are being used [14,16,21]. In this paper, we describe our experience with the adaptation of diving masks (Fig. 1) and predesigned and 3D-printed pieces (Annex) that