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A quantitative evaluation of aerosol generation during tracheal intubation and extubation
- Source :
- Anaesthesia, Brown, J, Gregson, F K A, Shrimpton, A J, Cook, T M, Bzdek, B R, Reid, J P & Pickering, A E 2021, ' A quantitative evaluation of aerosol generation during tracheal intubation and extubation ', Anaesthesia, vol. 76, no. 2, pp. 174-181 . https://doi.org/10.1111/anae.15292, https://doi.org/10.1111/anae.15292, Brown, J, Gregson, F K A, Shrimpton, A, Cook, T M, Bzdek, B R, Reid, J P & Pickering, A E 2021, ' A quantitative evaluation of aerosol generation during tracheal intubation and extubation ', Anaesthesia, vol. 76, no. 2, pp. 174-181 . https://doi.org/10.1111/anae.15292
- Publication Year :
- 2020
- Publisher :
- Wiley, 2020.
-
Abstract
- 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.
- Subjects :
- Operating Rooms
medicine.medical_treatment
law.invention
0302 clinical medicine
030202 anesthesiology
law
Extubation
Intubation
Medicine
Anesthesia
030212 general & internal medicine
Prospective Studies
Airway Management
aerosol‐generating procedure
Covid19
respiratory system
Ventilation (architecture)
Original Article
Risk assessment
AERATOR
Environmental Monitoring
SARS‐COV‐2
2019-20 coronavirus outbreak
extubation
Coronavirus disease 2019 (COVID-19)
Patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
UNCOVER
SARS-COV-2
Airway Extubation
intubation
03 medical and health sciences
COVID‐19
Correspondence
Intubation, Intratracheal
Humans
Particle Size
Personal protective equipment
Personal Protective Equipment
Aerosols
business.industry
SARS-CoV-2
Tracheal intubation
COVID-19
Original Articles
Respiration, Artificial
Ventilation
Aerosol
Anesthesiology and Pain Medicine
Cough
Aerosol Generating Procedure
Anesthetists
Airway management
business
Anaesthesia Pain and Critical Care
Subjects
Details
- Language :
- English
- ISSN :
- 13652044 and 00032409
- Database :
- OpenAIRE
- Journal :
- Anaesthesia
- Accession number :
- edsair.doi.dedup.....a6f55acf83b0b7f36b0cc2a7bd177faf
- Full Text :
- https://doi.org/10.1111/anae.15292