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Negative pressure patient isolation device to enable non-invasive respiratory support for COVID-19 and beyond
  1. Auriel August1,2,
  2. Mariel Bolhouse2,
  3. Brian Rice3,
  4. James Kennedy Wall4,5
  1. 1 General Surgery, Stanford Medicine, Stanford, California, USA
  2. 2 Biodesign, Stanford University, Palo Alto, California, USA
  3. 3 Emergency Medicine, Stanford Medicine, Stanford, California, USA
  4. 4 Pediatric Surgery, Stanford Children's Health, Palo Alto, California, USA
  5. 5 Bioengineering, Stanford University, Palo Alto, California, USA
  1. Correspondence to Dr Auriel August, General Surgery, Stanford Medicine, Stanford, CA 94305, USA; ataugust{at}

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Summary box

What are the new findings?

  • Nosocomial spread of COVID-19 and other airborne infectious diseases can occur during non-invasive aerosolising procedures.

  • The in-room suction system in most hospitals can generate enough pressure to create a negative pressure environment around a patient’s head.

  • The ARIEL is an effective and low-cost solution to allow safe, widespread use of non-invasive positive pressure respiratory support devices.

How might it impact on healthcare in the future?

  • Effective, low cost and packable solutions are required to enable deployment at scale.

  • Nosocomial spread of COVID-19 and other airborne infectious diseases will continue to be a threat and infrastructure such as The ARIEL can help mitigate this risk.


As healthcare systems adapt to living with the SARS-CoV-2 virus, the risk of aerosolising infectious viral particles has emerged as an ongoing threat in hospitals when treating patients suspected or confirmed to have COVID-19; especially as we head into a second wave this winter.

SARS-CoV-2 is primarily a droplet contagion, spreading through close contact with respiratory droplets of an infected person.1 Droplet particles range from 5 to 100 µm and remain suspended in the air for just seconds in the wake of an infected individual.2 In contrast, aerosol particles are <5 µm, can travel over 10 m and can remain suspended for hours in the wake of an infected person. As we learn more about SARS-CoV-2 there is mounting concern that aerosols are a significant driver of transmission.3–6 There are certain respiratory interventions performed that generate aerosols from the patient and thus have become a cause for concern as SARS-CoV-2 continues to spread. The aforementioned non-invasive aerosolising procedures (NAPs) include, but are not limited to, high flow nasal cannula, medication nebulisers, continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP).7 These are all important intermediate options for respiratory support for patients prior to needing invasive intubation.

Due to the risk of …

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  • Contributors The concept, execution and analysis of this study was conceived by AA and MB. Drafting of the manuscript was completed by AA with significant input by MB. Guidance and mentorship of both the project and the manuscript was provided by BR and JKW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.