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Tytuł:
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Airborne Aerosol Generation During Endonasal Procedures in the Era of COVID-19: Risks and Recommendations.
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Autorzy:
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Workman AD; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Jafari A; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Welling DB; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Varvares MA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Gray ST; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Holbrook EH; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Scangas GA; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Xiao R; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Carter BS; Harvard Medical School, Boston, Massachusetts, USA.; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Curry WT; Harvard Medical School, Boston, Massachusetts, USA.; Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Bleier BS; Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
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Źródło:
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Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2020 Sep; Vol. 163 (3), pp. 465-470. Date of Electronic Publication: 2020 May 26.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 2023- : [Oxford] : Wiley
Original Publication: [Rochester, Minn.] : The Academy, [c1981-
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MeSH Terms:
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Otorhinolaryngologic Surgical Procedures*
Aerosols/*adverse effects
Coronavirus Infections/*transmission
Nose/*virology
Pneumonia, Viral/*transmission
Betacoronavirus ; COVID-19 ; Cadaver ; Endoscopy ; Humans ; Pandemics ; Particle Size ; Personal Protective Equipment ; Prospective Studies ; Risk Factors ; SARS-CoV-2
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References:
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Contributed Indexing:
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Keywords: COVID-19; aerosol-generating procedure; aerosol-generating surgery; aerosolization; airborne; endoscopy; nasal endoscopy
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Substance Nomenclature:
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0 (Aerosols)
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Entry Date(s):
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Date Created: 20200527 Date Completed: 20200910 Latest Revision: 20210110
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Update Code:
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20240105
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PubMed Central ID:
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PMC7251624
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DOI:
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10.1177/0194599820931805
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PMID:
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32452739
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Objective: In the era of SARS-CoV-2, the risk of infectious airborne aerosol generation during otolaryngologic procedures has been an area of increasing concern. The objective of this investigation was to quantify airborne aerosol production under clinical and surgical conditions and examine efficacy of mask mitigation strategies.
Study Design: Prospective quantification of airborne aerosol generation during surgical and clinical simulation.
Setting: Cadaver laboratory and clinical examination room.
Subjects and Methods: Airborne aerosol quantification with an optical particle sizer was performed in real time during cadaveric simulated endoscopic surgical conditions, including hand instrumentation, microdebrider use, high-speed drilling, and cautery. Aerosol sampling was additionally performed in simulated clinical and diagnostic settings. All clinical and surgical procedures were evaluated for propensity for significant airborne aerosol generation.
Results: Hand instrumentation and microdebridement did not produce detectable airborne aerosols in the range of 1 to 10 μm. Suction drilling at 12,000 rpm, high-speed drilling (4-mm diamond or cutting burs) at 70,000 rpm, and transnasal cautery generated significant airborne aerosols ( P < .001). In clinical simulations, nasal endoscopy ( P < .05), speech ( P < .01), and sneezing ( P < .01) generated 1- to 10-μm airborne aerosols. Significant aerosol escape was seen even with utilization of a standard surgical mask ( P < .05). Intact and VENT-modified (valved endoscopy of the nose and throat) N95 respirator use prevented significant airborne aerosol spread.
Conclusion: Transnasal drill and cautery use is associated with significant airborne particulate matter production in the range of 1 to 10 μm under surgical conditions. During simulated clinical activity, airborne aerosol generation was seen during nasal endoscopy, speech, and sneezing. Intact or VENT-modified N95 respirators mitigated airborne aerosol transmission, while standard surgical masks did not.
