Is High-Flow Nasal Cannula Oxygen Therapy an Aerosol-Generating Medical Procedure?
Is High-Flow Nasal Cannula Oxygen Therapy an Aerosol-Generating Medical Procedure?
复制标题
DOI：
10.1016/j.arbres.2021.01.011
复制
发表时间：
2021-02-03
影响因子：
8
通讯作者：
Hirai T
中科院分区：
文献类型：
--
作者：
Hamada S;Tanabe N;Inoue H;Hirai T
由严重急性呼吸综合征-2型冠状病毒引起的2019冠状病毒病（COVID-19）的全球发病率正在急剧上升。大多数COVID-19病例只有轻微症状或无症状1；然而，COVID-19也可引起弥漫性肺泡损伤，导致急性低氧性呼吸衰竭（AHRF），在很大比例的病例中，需要住进重症监护室并进行机械通气。高流量鼻插管（HFNC）氧疗是AHRF典型的处方呼吸治疗。最近，重症医学学会（SCCM）和世界卫生组织（WHO）都建议在COVID-19引起的AHRF中使用HFNC氧疗。然而，HFNC氧疗是否是一种产生气溶胶的医疗程序（AGMP）仍然存在争议——世卫组织将这种疗法视为一种产生气溶胶的医疗程序，而SCCM则不这样认为。呼吸道气溶胶的产生和扩散已通过几种方法进行评估，如烟雾光探测成像、纹影成像、激光光散射和气溶胶粒径计（APS）光谱仪。使用这些成像方法的大多数研究通过使用烟雾和人体模型来检查呼出的气体。5 Gaeckle等人使用APS光谱仪，提出HFNC氧疗不增加气溶胶浓度。6小时后，他们在负压室中通过距离口腔约5厘米的漏斗收集呼出的气体；因此，他们无法评估呼吸道气溶胶的总浓度。本报告采用新型细颗粒可视化系统和APS光谱仪进行两项实验，以评估接受HFNC氧疗时呼吸道颗粒弥散是否增加。第一次实验试验进行了使用相同的过程,我们之前研究7和四个场景中,一个健康的v olunteer使用设备,如鼻插管4 L / min和HFNC (AIRVOTM2设备与一个OptiflowTM鼻接口(Fisher & Paykel,奥克兰,新西兰))没有氧气40 L /分钟的流量和温度37◦c .粒子分散是由一组摄像机可视化为29.97帧每秒(眼睛范围、胫骨日本空气技术,东京,日本)。该系统使用发光二极管（波长400-410 nm； Parallel Eye D, Shin Nippon Air Technologies），可显示直径≥1 m的颗粒。使用商业软件（Particle Eye, Shin Nippon Air Technologies）将获得的图像重建为视频。第二次实验使用APS光谱仪（型号3321，TSI Inc., St. Paul， MN， USA），在5名健康志愿者中使用4 L/min的鼻插管和40 L/min的流量和37℃的无氧HFNC等设备测量颗粒的空气动力学直径，范围为0.52-20 m。同时拿着植入与APS光谱仪连接的盒子（尺寸：39.0× 33.5× 14.5 mm）的吸口。APS光谱仪以5 L/min的流量抽吸空气，其中1 L/min进入测量区，4 L/min过滤后作为仪器护套流动的空气；1-s光谱数据重复采集60 s。
The global incidence of coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndromecoronavirus-2, is increasing dramatically. Most COVID-19 cases present with only mild symptoms or no symptoms 1; however, COVID-19 can also cause diffuse alveolar damage resulting in acute hypoxemic respiratory failure (AHRF), which requires intensive care unit admission and mechanical ventilation in a high percentage of cases. 2 High-flow nasal cannula (HFNC) oxygen therapy is typically the prescribed respiratory therapy for AHRF. Rece ntly both the Society of Critical Care Medicine (SCCM) 3 and the World Health Organization (WHO) 4 have recommended the use of HFNC oxygen therapy in AHRF caused by COVID-19. However, whether HFNC oxygen therapy is an aerosol generating medical procedure (AGMP) remains controversial—the WHO regards this therapy as an AGMP, 4 w hereas the SCCM does not. 3 Respiratory aerosol generation and dispersion have been assessed by several methods, such as imaging with smoke light detection, schlieren imaging, and laser light scattering and aerosol particle sizer (APS) spectrometer. 5 M ost studies using these imaging methods examined exhaled breath by using smoke and a mannequin. 5 Gaeckle et al. used an APS spectrometer and proposed that HFNC oxygen therapy did not increase the aero sol concentration. 6 H owever, they collected exhaled breath in a negative pressure room through a funnel approximately 5 cm away from the mouth; therefore, they could not evaluate the total aerosol concentration from respiratory tract. This current report represents two experimental trials with a novel fine particle visualization system and an APS spectrometer to evaluate whether particle dispersion from the respiratory tract increases while receiving HFNC oxygen therapy.The first experimental trial was conducted using the same procedure as our previous study 7 a nd four scenarios in which a healthy v olunteer used devices such as nasal cannula at 4 L/min and HFNC (AIRVOTM2 device with an OptiflowTM nasal interface [Fisher & Paykel, Auckland, New Zealand]) without oxygen at a flow rate of 40 L/min and temperature of 37◦ C. Particle dispersion was visualized by a video camera set at 29.97 frames per second (Eye Scope, Shin Nippon Air Technologies, Tokyo, Japan). This system used a light-emitting diode (wavelength 400–410 nm; Parallel Eye D, Shin Nippon Air Technologies), which visualized particle≥ 1 m in diameter. Images obtained were reconstructed as videos using a commercial software (Particle Eye, Shin Nippon Air Technologies). The second experimental trial was performed with an APS spectrometer (model 3321, TSI Inc., St. Paul, MN, USA), which made it pos sible to measure the aerodynamic diameter of particles ranging from 0.52–20 m, in 5 healthy volunteers using devices such as nasal cannula at 4 L/min and HFNC without oxygen at a flow rate of 40 L/min and temperature of 37◦ C. Volunteers inhaled through the nose and exhaled through the mouth under normal breathing conditions, while holding a mouthpiece implanted in a box (size: 39.0× 33.5× 14.5 mm) connected to the APS spectrometer. The APS spectrometer drew air at a flow of 5 L/min with 1 L/min directed to the measurement zone and 4 L/min filtered and used as air for sheath flow in the instrument; 1-s spectra data were collected repeatedly for 60 s.
从呼吸道产生的气溶胶以各种氧气递送方式产生。
DOI：
10.1164/rccm.202006-2309oc
发表时间：
2020-10-15
影响因子：
24.7
作者：
Gaeckle NT;Lee J;Park Y;Kreykes G;Evans MD;Hogan CJ Jr
通讯作者：
Hogan CJ Jr
影响因子：
8.8
作者：
Alhazzani, Waleed;Moller, Morten Hylander;Rhodes, Andrew
通讯作者：
Rhodes, Andrew