A quantitative evaluation of aerosol generation during tracheal intubation and extubation.
A quantitative evaluation of aerosol generation during tracheal intubation and extubation.
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DOI：
10.1111/anae.15292
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发表时间：
2021-03
期刊：
影响因子：
10.7
通讯作者：
Pickering AE
中科院分区：
文献类型：
--
作者：
Brown J;Gregson FKA;Shrimpton A;Cook TM;Bzdek BR;Reid JP;Pickering AE
严重急性呼吸综合征冠状病毒-2的潜在气雾化传播是全球关注的问题。对于被视为产生气雾剂的医疗程序，普遍要求采取空中预防措施、个人防护装备和预防措施。这些措施的实施正在对医疗保健的提供产生巨大影响。目前缺乏关于气雾剂产生过程中产生的空气悬浮颗粒物的数量和大小的定量证据，以便为风险评估提供信息。为了解决这一证据差距，我们在气管插管和拔管过程中，在超净通风手术室进行了实时、高分辨率的环境监测。利用光学粒度仪的连续采样，可以确定患者和麻醉师之间区域内气雾剂生成的特征。气溶胶监测显示，背景颗粒物计数非常低(0.4个颗粒物1−1)，可以解决与呼吸道管理相关的空气颗粒物短暂增加的问题。作为阳性参照对照，我们定量了在相同环境下由任意性咳嗽产生的气雾剂(平均浓度，732(418)个颗粒物。l−1，n=38)。包括面罩通风在内的气管插管产生的雾化颗粒物数量非常低(平均浓度为1.4万个颗粒物。l−1，n=0.14，P<0.0001)。气管拔管，特别是当患者咳嗽时，会产生可检测到的气雾剂(21(18)与L−1，n=10)，比插管时大15倍(p=0.0004)，但比任意性咳嗽(p<0.0001)小35倍。这项研究不支持将选择性气管插管指定为气雾剂产生程序。拔管比插管产生更多可检测到的气溶胶，但低于目前被指定为高风险气溶胶产生程序的标准。这些来自常规医疗保健环境中的实时气溶胶检测的新发现为风险评估提供了一种量化方法，可以扩展到其他呼吸道管理技术和临床环境。它们还表明有必要重新评估什么是气雾剂产生程序，以及常规麻醉呼吸道管理的相关预防措施。
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.
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影响因子：
1.2
作者：
Davies, A.;Thomson, G.;Bennett, A.
通讯作者：
Bennett, A.
DOI：
10.1073/pnas.2009637117
发表时间：
2020-06-30
影响因子：
11.1
作者：
Zhang, Renyi;Li, Yixin;Molina, Mario J.
通讯作者：
Molina, Mario J.
影响因子：
12.7
作者：
Stelzer-Braid, Sacha;Oliver, Brian G.;Tovey, Euan R.
通讯作者：
Tovey, Euan R.
气溶胶生成程序和将急性呼吸道感染传播给医疗保健工作者的风险：系统评价。
影响因子：
3.7
作者：
Tran K;Cimon K;Severn M;Pessoa-Silva CL;Conly J
通讯作者：
Conly J
影响因子：
3.1
作者：
Zayas G;Chiang MC;Wong E;MacDonald F;Lange CF;Senthilselvan A;King M
通讯作者：
King M