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Tytuł:
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A quantitative evaluation of aerosol generation during tracheal intubation and extubation.
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Autorzy:
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Brown J; Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK.
Gregson FKA; School of Chemistry, University of Bristol, Bristol, UK.
Shrimpton A; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
Cook TM; Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK.
Bzdek BR; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
Reid JP; School of Chemistry, University of Bristol, Bristol, UK.
Pickering AE; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.; University Hospitals Bristol, Bristol, UK.
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Źródło:
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Anaesthesia [Anaesthesia] 2021 Feb; Vol. 76 (2), pp. 174-181. Date of Electronic Publication: 2020 Oct 22.
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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: Oxford, UK : Wiley-Blackwell
Original Publication: London, Academic Press; New York, Grune & Stratton.
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MeSH Terms:
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Aerosols*
Airway Extubation*
Intubation, Intratracheal*
COVID-19/*transmission
Airway Management ; Anesthesia ; Anesthetists ; Cough ; Environmental Monitoring ; Humans ; Operating Rooms ; Particle Size ; Patients ; Personal Protective Equipment ; Prospective Studies ; Respiration, Artificial ; SARS-CoV-2 ; Ventilation
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References:
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Grant Information:
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COV0333 United Kingdom DH_ Department of Health; NIHR301520 United Kingdom DH_ Department of Health; NE/P018459/1 Natural Environment Research Council (GB); EBI950 Elizabeth Blackwell Institute - University of Bristol
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Contributed Indexing:
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Keywords: COVID-19; SARS-COV-2; aerosol-generating procedure; extubation; intubation
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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: 20201006 Date Completed: 20210114 Latest Revision: 20211213
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Update Code:
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20240105
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PubMed Central ID:
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PMC7675579
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DOI:
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10.1111/anae.15292
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PMID:
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33022093
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The potential aerosolised transmission of severe acute respiratory syndrome coronavirus-2 is of global concern. Airborne precaution personal protective equipment and preventative measures are universally mandated for medical procedures deemed to be aerosol generating. The implementation of these measures is having a huge impact on healthcare provision. There is currently a lack of quantitative evidence on the number and size of airborne particles produced during aerosol-generating procedures to inform risk assessments. To address this evidence gap, we conducted real-time, high-resolution environmental monitoring in ultraclean ventilation operating theatres during tracheal intubation and extubation sequences. Continuous sampling with an optical particle sizer allowed characterisation of aerosol generation within the zone between the patient and anaesthetist. Aerosol monitoring showed a very low background particle count (0.4 particles.l -1 ) allowing resolution of transient increases in airborne particles associated with airway management. As a positive reference control, we quantitated the aerosol produced in the same setting by a volitional cough (average concentration, 732 (418) particles.l -1 , n = 38). Tracheal intubation including facemask ventilation produced very low quantities of aerosolised particles (average concentration, 1.4 (1.4) particles.l -1 , n = 14, p < 0.0001 vs. cough). Tracheal extubation, particularly when the patient coughed, produced a detectable aerosol (21 (18) l -1 , n = 10) which was 15-fold greater than intubation (p = 0.0004) but 35-fold less than a volitional cough (p < 0.0001). The study does not support the designation of elective tracheal intubation as an aerosol-generating procedure. Extubation generates more detectable aerosol than intubation but falls below the current criterion for designation as a high-risk aerosol-generating procedure. These novel findings from real-time aerosol detection in a routine healthcare setting provide a quantitative methodology for risk assessment that can be extended to other airway management techniques and clinical settings. They also indicate the need for reappraisal of what constitutes an aerosol-generating procedure and the associated precautions for routine anaesthetic airway management.
(© 2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)
Comment in: Anaesthesia. 2021 Mar;76 Suppl 3:13-14. (PMID: 33169833)
Comment in: Anaesthesia. 2021 Mar;76 Suppl 3:14-15. (PMID: 33169836)
Comment in: Anaesthesia. 2021 Mar;76 Suppl 3:15-16. (PMID: 33227146)
Comment in: Anaesthesia. 2021 Feb;76(2):151-155. (PMID: 33274761)
Comment in: Anaesthesia. 2021 Mar;76 Suppl 3:27-28. (PMID: 33280082)
