Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID-19 pandemic
Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID-19 pandemic
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DOI：
10.1111/anae.15188
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发表时间：
2020-07-09
期刊：
影响因子：
10.7
通讯作者：
Chan, P. Y.
中科院分区：
文献类型：
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作者：
Simpson, J. P.;Wong, D. N.;Chan, P. Y.
COVID-19大流行导致生产新型设备，旨在在气管插管的气溶胶生成过程中保护气道管理人员。使用原位模拟模型，我们评估了喉镜医生暴露于0.3 - 5.0微米的空气中颗粒，使用五种气溶胶密封装置（气溶胶盒;有和没有吸力的密封盒;垂直铺巾;和水平铺巾）与没有气溶胶密封装置相比。雾化盐水用作气溶胶生成模型300 s，此时，取出器械以评估颗粒扩散。主要结局是在30、60、120和300 s以及360 s（器械取出后60 s）时在喉镜医生头部水平测量的空气传播颗粒的数量和尺寸。使用电子气载颗粒计数器对0.3、0.5、1.0、2.5和5.0微米的气载颗粒进行定量。与未使用器械相比，在所有时间段内，带抽吸的密封插管盒导致0.3、0.5、1.0和2.5 μ m颗粒暴露减少，但未导致5.0 μ m颗粒暴露减少（所有时间段p = 0.003）。与未使用器械相比，气雾剂盒显示在300 s时1.0、2.5和5.0 μ m气载颗粒暴露增加（分别为p = 0.002、0.008、0.002）。与未使用器械相比，水平或垂直铺巾在任何时间的任何粒度暴露均无任何差异。最后，当患者咳嗽时，与其他器械或不使用器械相比，使用气雾剂盒导致空气颗粒暴露显著增加。总之，预期用于保护喉镜医生的新型器械需要进行客观测试，以确保其符合目的，并且不会导致空气中颗粒物暴露增加。
The COVID-19 pandemic has led to the production of novel devices intended to protect airway managers during the aerosol-generating procedure of tracheal intubation. Using an in-situ simulation model, we evaluated laryngoscopist exposure of airborne particles sized 0.3 - 5.0 microns using five aerosol containment devices (aerosol box; sealed box with and without suction; vertical drape; and horizontal drape) compared with no aerosol containment device. Nebulised saline was used as the aerosol-generating model for 300 s, at which point, the devices were removed to assess particle spread. Primary outcome was the quantity and size of airborne particles measured at the level of the laryngoscopist's head at 30, 60, 120 and 300 s, as well as 360 s (60 s after device removal). Airborne particles sizes of 0.3, 0.5, 1.0, 2.5 and 5.0 microns were quantified using an electronic airborne particle counter. Compared with no device use, the sealed intubation box with suction resulted in a decrease in 0.3, 0.5, 1.0 and 2.5 micron, but not 5.0 micron, particle exposure over all time-periods (p = 0.003 for all time periods). Compared with no device use, the aerosol box showed an increase in 1.0, 2.5 and 5.0 micron airborne particle exposure at 300 s (p = 0.002, 0.008, 0.002, respectively). Compared with no device use, neither horizontal nor vertical drapes showed any difference in any particle size exposure at any time. Finally, when the patient coughed, use of the aerosol box resulted in a marked increase in airborne particle exposure compared with other devices or no device use. In conclusion, novel devices intended to protect the laryngoscopist require objective testing to ensure they are fit for purpose and do not result in increased airborne particle exposure.