Quantifying Viral Particle Aerosolization Risk During Tracheostomy Surgery and Tracheostomy Care
Quantifying Viral Particle Aerosolization Risk During Tracheostomy Surgery and Tracheostomy Care
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DOI：
10.1001/jamaoto.2021.1383
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发表时间：
2021-07-22
影响因子：
7.8
通讯作者：
Hillel, Alexander T.
中科院分区：
文献类型：
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作者：
Berges, Alexandra J.;Lina, Ioan A.;Hillel, Alexander T.
在COVID-19大流行等呼吸道疾病暴发期间，产生气溶胶的手术，包括气管切开术，与病毒传播给卫生保健工作者的风险相关。目的量化气管切开术和气管切开术护理期间的颗粒雾化，并评估将病毒颗粒暴露风险降至最低的干预措施。设计、环境和参与者本比较有效性研究于2020年8月至2021年1月在一家三级医疗学术机构进行。用光学粒子计数器实时测量模拟（人体）气管切开术和临床条件下的气溶胶生成，包括咳嗽、气道雾化、开放吸引和电灼。在猪体内气管切开术过程中（n = 4）也进行了气溶胶取样，有或没有电灼。用荧光染料观察猪气管造口术中咳嗽扩散到手术野的情况。最后，将6个气管造口覆盖物与无气管造口覆盖物进行比较，以量化颗粒雾化的减少。主要观察结果和测量方法：可吸入雾化颗粒浓度。结果：咳嗽、气道湿化、开放吸痰和电灼产生的气溶胶颗粒大大高于基线。与未覆盖气管造口术相比，使用气管造口覆盖物可减少雾化，包括棉面罩（73.8% [95% CI, 63.0%-84.5%]; d = 3.8），聚酯绑带(79.5%[95% CI, 68.7%-90.3%]；d = 7.2)、加湿口罩（82.8%[95% CI, 72.0% ~ 93.7%], d = 8.6）、热交换器（HME） （91.0% [95% CI, 80.2% ~ 101.7%], d = 19.0）、外科口罩（89.9% [95% CI, 79.3% ~ 100.6%], d = 12.8）。与单独使用外科口罩（95% CI, 1.6%-12.3%; Cohen d = 1.2）或外科口罩（95% CI, 2.7%-13.2%; d = 1.9）相比，同时使用外科口罩和HME可降低颗粒浓度。电气化过程使总雾化颗粒每5秒间隔增加1500个颗粒/m(3) (95% CI， 1380-1610个颗粒/m(3))；D = 1.8)。结论和相关性本实验室和动物有效性比较研究的结果表明，气管造口手术和气管造口护理与显著的气溶胶产生相关，使卫生保健工作者面临空气传播疾病的病毒传播风险。气管切开术时联合使用HME和外科口罩可减少雾化，从而降低病毒向卫生保健工作者传播的风险。
IMPORTANCE During respiratory disease outbreaks such as the COVID-19 pandemic, aerosol-generating procedures, including tracheostomy, are associated with the risk of viral transmission to health care workers.OBJECTIVE To quantify particle aerosolization during tracheostomy surgery and tracheostomy care and to evaluate interventions that minimize the risk of viral particle exposure.DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness studywas conducted from August 2020 to January 2021 at a tertiary care academic institution. Aerosol generation was measured in real time with an optical particle counter during simulated (manikin) tracheostomy surgical and clinical conditions, including cough, airway nebulization, open suctioning, and electrocautery. Aerosol sampling was also performed during in vivo swine tracheostomy procedures (n = 4), with or without electrocautery. Fluorescent dye was used to visualize cough spread onto the surgical field during swine tracheostomy. Finally, 6 tracheostomy coverings were compared with no tracheostomy covering to quantify reduction in particle aerosolization.MAIN OUTCOMES AND MEASURES Respirable aerosolized particle concentration.RESULTS Cough, airway humidification, open suctioning, and electrocautery produced aerosol particles substantially above baseline. Compared with uncovered tracheostomy, decreased aerosolization was found with the use of tracheostomy coverings, including a cotton mask (73.8% [(95% CI, 63.0%-84.5%]; d = 3.8), polyester gaiter 79.5%[95% CI, 68.7%-90.3%]; d = 7.2), humidification mask (82.8%[95% CI, 72.0%-93.7%]; d = 8.6), heat moisture exchanger (HME) (91.0% [95% CI, 80.2%-101.7%]; d = 19.0), and surgical mask (89.9% [95% CI, 79.3%-100.6%]; d = 12.8). Simultaneous use of a surgical mask and HME decreased the particle concentration compared with either the HME (95% CI, 1.6%-12.3%; Cohen d = 1.2) or surgical mask (95% CI, 2.7%-13.2%; d = 1.9) used independently. Procedures performed with electrocautery increased total aerosolized particles by 1500 particles/m(3) per 5-second interval (95% CI, 1380-1610 particles/m(3) per 5-second interval; d = 1.8).CONCLUSIONS AND RELEVANCE The findings of this laboratory and animal comparative effectiveness study indicate that tracheostomy surgery and tracheostomy care are associated with significant aerosol generation, putting health care workers at risk for viral transmission of airborne diseases. Combined HME and surgical mask coverage of the tracheostomy was associated with decreased aerosolization, thereby reducing the risk of viral transmission to health care workers.