Aerosolisation during tracheal intubation and extubation in an operating theatre setting

被引:46
作者
Dhillon, R. S. [1 ]
Rowin, W. A. [2 ]
Humphries, R. S. [3 ]
Kevin, K. [2 ]
Ward, J. D. [3 ]
Phan, T. D. [4 ,5 ]
Nguyen, L. V. [1 ]
Wynne, D. D. [1 ]
Scott, D. A. [4 ,5 ]
机构
[1] St Vincents Hosp Melbourne, Dept Neurosurg, Fitzroy, Vic, Australia
[2] Univ Melbourne, Dept Mech Engn, Parkville, Vic, Australia
[3] CSIRO Oceans & Atmosphere, Climate Sci Ctr, Aspendale, Vic, Australia
[4] Univ Melbourne, Fitzroy, Vic, Australia
[5] St Vincents Hosp Melbourne, Dept Anaesthesia & Acute Pain Med, Fitzroy, Vic, Australia
基金
英国医学研究理事会;
关键词
aerosol‐ generating procedures; extubation; intubation; occupational exposure; INFECTION; DROPLETS;
D O I
10.1111/anae.15301
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Aerosol-generating procedures such as tracheal intubation and extubation pose a potential risk to healthcare workers because of the possibility of airborne transmission of infection. Detailed characterisation of aerosol quantities, particle size and generating activities has been undertaken in a number of simulations but not in actual clinical practice. The aim of this study was to determine whether the processes of facemask ventilation, tracheal intubation and extubation generate aerosols in clinical practice, and to characterise any aerosols produced. In this observational study, patients scheduled to undergo elective endonasal pituitary surgery without symptoms of COVID-19 were recruited. Airway management including tracheal intubation and extubation was performed in a standard positive pressure operating room with aerosols detected using laser-based particle image velocimetry to detect larger particles, and spectrometry with continuous air sampling to detect smaller particles. A total of 482,960 data points were assessed for complete procedures in three patients. Facemask ventilation, tracheal tube insertion and cuff inflation generated small particles 30-300 times above background noise that remained suspended in airflows and spread from the patient's facial region throughout the confines of the operating theatre. Safe clinical practice of these procedures should reflect these particle profiles. This adds to data that inform decisions regarding the appropriate precautions to take in a real-world setting.
引用
收藏
页码:182 / 188
页数:7
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