Surgical InfectionsVol. 21, No. 8 Letters to the EditorFree AccessConsiderations for the Use of Respiratory Filters in Children during the COVID-19 PandemicAlexander Trujillo and Sandra Ximena Jaramillo RincónAlexander TrujilloAddress correspondence to: Dr. Alexander Trujillo, Department of Surgery, Faculty of Health Sciences, Caldas University, Manizales, Colombia E-mail Address: [email protected]Medicine Program, Faculty of Health Sciences, Universidad de Manizales, Manizales, Colombia.Surgical Department, Faculty of Health Sciences, Universidad de Caldas. Manizales, Colombia.Search for more papers by this author and Sandra Ximena Jaramillo RincónAnesthesia Department, Faculty of Medicine, Universidad de los Andes. Clínica de Marly, Bogotá, Colombia.Search for more papers by this authorPublished Online:18 Sep 2020https://doi.org/10.1089/sur.2020.200AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail To the Editor:Since the emergence of the coronavirus disease 2019 (COVID-19) pandemic, several recommendations have been made to improve the safety of health workers and patients. The addition of filters in respiratory circuits has been recommended by the American Association of Anesthesiology [1] and by the Anesthesia Patient Safety Foundation [2]. However, some institutions have decided to remove the Y filters from the anesthetic circuit because they have presented cases of severe hypercapnia in pediatric patients [3]. But is this a correct decision? Is the risk of contagion lower when caring for children? What considerations should be taken into account to use filters in this population?There is evidence that the air dispersion distance is in direct relation to the volume administered during positive pressure ventilation. Thus, when ventilating a newborn weighing 3 kg with a tidal volume between 15 and 18 mL (5–6 mL/kg), the air dispersion distance is 1.5 to 1.8 cm [4]. However, an 8-mL filter (the smallest size available) has a tidal volume range between 30 and 200 mL, which is very large for neonates and premature infants and increases dead space considerable. These small filters are usually electrostatic with less filtration efficiency compared with mechanical filters. There are no mechanical filters less than 150 mL. This information, plus the absence of reported cases of COVID-19 in premature infants to date, makes it reasonable not to use filters for positive pressure ventilation under mask becaues of the risk of hypercapnia and intraventricular hemorrhage in premature infants and the lower risk of contagion for healthcare personnel. However, for older patients who require a larger tidal volume, the aerosol dispersion distance may be longer and the use of filters provide additional protection. In these cases, the appropriate size filter must be chosen for the patient weight, taking into account the tidal volume range it allows and the dead space it generates. This information is supplied by each manufacturer and is visible on the product label. In any case, the anesthesia machine should always be protected with a large mechanical filter placed on the expiratory path of the respiratory circuit. This location does not generate increased dead space for the patient. Additionally, the gases sampled from the anesthetic circuit must be filtered, otherwise they must not return to the respiratory circuit again and must be directed towards the evacuation system.In summary, the decision to place filters on the Y of the anesthetic circuit in pediatric patients requires clinical judgment and should not be a standard measure for all cases. The risk and benefit should also be considered, especially in smaller patients.References1. American Society of Anesthesiology Committee on Occupational Health. Coronavirus clinical FAQs. www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus/clinical-faqs (Last accessed May 24, 2020). Google Scholar2. Anesthesia Patient Safety Foundation. Anesthesia Machine FAQs. www.apsf.org/faq-on-anesthesia-machine-use-protection-and-decontamination-during-the-covid-19-pandemic/ (Last accessed May 24, 2020). Google Scholar3. Schrock CR, Montana M. Rapid COVID-19-related clinical adaptations and unanticipated risks. Anesthesiology [[Epub ahead of print: DOI: 10.1097/ALN.0000000000003333]. Crossref, Google Scholar4. Shalish W, Lakshminrusimha S, Manzoni P, et al. COVID-19 and neonatal respiratory care: Current evidence and practical approach. Am J Perinatol [Epub ahead of print: DOI: 10.1055/s-0040-1710522]. Crossref, Google ScholarFiguresReferencesRelatedDetailsCited byAssociated risks with the use of surgical face mask in children during the COVID-19 pandemic23 March 2021 | Colombian Journal of Anesthesiology, Vol. 49, No. 3 Volume 21Issue 8Oct 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Alexander Trujillo and Sandra Ximena Jaramillo Rincón.Considerations for the Use of Respiratory Filters in Children during the COVID-19 Pandemic.Surgical Infections.Oct 2020.728-728.http://doi.org/10.1089/sur.2020.200Published in Volume: 21 Issue 8: September 18, 2020Online Ahead of Print:June 10, 2020PDF download