Modified full-face snorkeling mask for thoracic surgery and otolaryngology surgical use: comfort and usability assessment of a novel personal protective equipment (PPE) during the COVID-19 pandemic Modified full-face snorkeling mask for surgical use in otolaryngologic and thoracic surgery

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Tommaso Cacco
Marco Fragale
Claudio Sampieri
Eolo Castello
Carlo Risso
Maria Teresa Piras
Paolo Durando
Giorgio Peretti
Gian Luca Pariscenti
Alfredo Montecucco


COVID-19, personal protective equipment, surgery, occupational health


Background: A worldwide personal protection equipment (PPE) shortage has emerged during COVID-19 pandemic, contributing to the high incidence of SARS-CoV-2 infection among health care providers. To address this lack of PEE, new solutions have been researched. Among those, full-face snorkeling masks demonstrated to be an interesting option. Among surgical specialties, otolaryngologists and thoracic surgeons, are at high risk of infection, due to the close contact with airway secretions.

Objectives: We tested comfort and usability of a modified full-face snorkeling mask (Ocean Reef Mask Aria QR+) as a protective device for otolaryngologic and thoracic surgeries.

Methods: The mask was customized with a 3D-printed adaptor supporting many industrial filter types, including FFP3 and heat and moisture exchangers (HME). We evaluated surgical performances of the mask, both subjectively, with a questionnaire filed by the surgeons, as well as objectively, monitoring transcutaneous PCO2 and PO2 values of surgeons during surgical procedures.

Results: The modified full-face snorkeling mask was tested during 9 otolaryngologic and 15 thoracic surgery procedures. The device demonstrated very good overall vision quality with some limitations regarding lateral vision and almost no difficulties in usability. Water condensation into the mask was absent in almost every case. Both PO2 and PCO2 parameters remained within normal ranges during every procedure.

Discussion: The modified full-face snorkeling mask can be an innovative PPE. In the current COVID-19 pandemic scenario, the worldwide shortage of protective masks and goggles may exploit this ready-to-use and low-cost solution, especially for high-risk surgical procedures


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(1)Banik RK, Ulrich AK. Evidence of short-range aerosol transmission of SARS-CoV-2 and call for universal airborne precautions for anesthesiologists during the COVID-19 pandemic. Anesth Analg. 2020 Apr 29.
(2)Centre for Disease Control and Prevention. Coronavirus Disease 2019: Optimize PPE Supply. Available online: Last accessed on the 6-05-2020
(3)Cherrie JW, Loh M, Aitken RJ. Protecting healthcare workers from inhaled SARS-CoV-2 virus. Occup Med (Lond). 2020 Apr 30.
(4)De Man P, van Straten B, van den Dobbelsteen J, van der Eijk A, et al. Sterilization of disposable face masks by means of standardized dry and steam sterilization processes; an alternative in the fight against mask shortages due to COVID-19. J Hosp Infect. 2020; 30176-6.
(5)Istituto Superiore di Sanità (ISS). Integrated Surveillance of COVID-19 in Italy (2020). Available on line at: . (Last accessed 6-05-2020).
(6)Italian Government - Decreto Legge 17 marzo 2020, n. 18 “Misure di potenziamento del Servizio sanitario nazionale e di sostegno economico per famiglie, lavoratori e imprese connesse all'emergenza epidemiologica da COVID-19” (2020). available on line at:;18!vig=2020-03-20. Last accessed on the 6-05-2020.
(7)Lisa M Brosseau. Are Powered Air Purifying Respirators a Solution for Protecting Healthcare Workers from Emerging Aerosol-Transmissible Diseases? Ann Work Expo Health. 2020 Apr 30;64(4):339-341.
(8)Liu, Y. et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. 2020 Apr 27.
(9)Ma QX, Shan H, Zhang CM, Zhang HL et al. Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID-19: experimental supports. J Med Virol. 2020;10.1002
(10)National Academies of Sciences, Engineering, and Medicine 2019. Reusable Elastomeric Respirators in Health Care: Considerations for Routine and SurgeUse. Washington, DC: The National Academies Press (2020). Available online: Last accessed on the 6-05-2020
(11)Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. N Engl J Med. 2020;382(18):e41.
(12)Sommer DD, Engels PT, Weitzel EK, Khalili S, et al. Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020; 49(1):23.
(13)Stephanie J Dancer, Julian W Tang, Linsey C Marr et al. Putting a Balance on the Aerosolization Debate Around SARS-CoV-2. J Hosp Infect. 2020 May 13.
(14)Van Doremalen N, Bushmaker T, Morris DH et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020 Apr 16;382(16):1564-1567.
(15)Wang J, Du G. COVID-19 may transmit through aerosol. Ir J Med Sci. 2020;1-2
(16)World Health organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations (2020). Available online at: . Last accessed 6-05- 2020.
(17)World Health organization. WHO Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020 (2020). Available online at: Last accessed on the 6-05-2020
(18) World Health organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 (2020). Available online at: Last accessed on the 6-05-2020