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Background: Patients with coronavirus disease (COVID-19) can develop severe hypoxemia. Meeting the soaring demands of oxygen may be a challenge. Objective: To test the efficacy of an easily handmade system, the double-trunk mask (DTM), in reducing oxygen consumption while maintaining patient’s oxygenation level. Methods: Hospitalized adults with COVID-19 and hypoxemia treated with low-flow oxygen therapy we recruited. The standard oxygen delivery system was replaced by the DTM with nasal cannula for 30 minutes with an oxygen output adapted to maintain an identical oxygen saturation by pulse oximetry. The standard oxygen delivery system was then reinstated for 30 minutes. Primary outcome was the absolute change in oxygen flow between the standard delivery systems and the DTM. Secondary outcomes were changes in blood gases, vital parameters and patient comfort. Results: Eleven patients were analyzed (mean age 61 years; 27% male). Compared with standard delivery systems, the oxygen output was significantly reduced with the DTM (median, 5 vs 1.5 L/min (95% CI -4 to -1.5, p=0.003)) when oxygen saturation and arterial oxygen tension remained stable. The DTM was also associated with a significant but slight increase in arterial carbon dioxide tension (median, 36 mmHg vs 37 mmHg, p=0.006), and respiratory rate (median, 26 vs 30 breaths/min, p=0.05). Other parameters were unaltered. The DTM was generally judged less comfortable than the baseline oxygen delivery system, especially in patients requiring low oxygen flow at baseline. Conclusions: The DTM is a simple and efficient system to reduce oxygen consumption. This may have clinical implications in places where oxygen supplies are limited.

Numerous cases of e-cigarette, or vaping, associated lung injury (EVALI) have recently prompted an investigation of the outbreak in the US [1]. Only two non-fatal cases have been reported so far in Europe: one case of hypersensitivity pneumonia in the UK after the use of flavoured e-cigarette liquid by a young adolescent [2], and one US imported case recently described in Spain [3]. To our knowledge, this is the first report of a fatal EVALI case in Europe. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Marliere has nothing to disclose. Conflict of interest: Dr. Hoton has nothing to disclose. Conflict of interest: Dr. De Greef has nothing to disclose. Conflict of interest: Dr. Belkhir has nothing to disclose. Conflict of interest: Dr. Jacquet has nothing to disclose. Conflict of interest: Dr. Wallemacq has nothing to disclose. Conflict of interest: Dr. Gohy has nothing to disclose.