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Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic.
J Otolaryngol Head Neck Surg. 2020 May 06; 49(1):28.JO

Abstract

BACKGROUND

Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations.

METHODS

A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category.

RESULTS

Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission.

CONCLUSIONS

During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols.

Authors+Show Affiliations

Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada. athamboo4@providencehealth.bc.ca.Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.Division of Otolaryngology Head & Neck Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.Department of Otolaryngology, Western University, London, ON, Canada.Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.Faculty of Medicine, University of British Columbia, Vancouver, Canada.Faculty of Medicine, University of British Columbia, Vancouver, Canada.Faculty of Medicine, University of British Columbia, Vancouver, Canada.Faculty of Medicine, University of British Columbia, Vancouver, Canada.Faculty of Medicine, University of British Columbia, Vancouver, Canada.Faculty of Medicine, University of British Columbia, Vancouver, Canada.Division of Otolaryngology Head & Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32375884

Citation

Thamboo, Andrew, et al. "Clinical Evidence Based Review and Recommendations of Aerosol Generating Medical Procedures in Otolaryngology - Head and Neck Surgery During the COVID-19 Pandemic." Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale, vol. 49, no. 1, 2020, p. 28.
Thamboo A, Lea J, Sommer DD, et al. Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020;49(1):28.
Thamboo, A., Lea, J., Sommer, D. D., Sowerby, L., Abdalkhani, A., Diamond, C., Ham, J., Heffernan, A., Cai Long, M., Phulka, J., Wu, Y. Q., Yeung, P., & Lammers, M. (2020). Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic. Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'oto-rhino-laryngologie Et De Chirurgie Cervico-faciale, 49(1), 28. https://doi.org/10.1186/s40463-020-00425-6
Thamboo A, et al. Clinical Evidence Based Review and Recommendations of Aerosol Generating Medical Procedures in Otolaryngology - Head and Neck Surgery During the COVID-19 Pandemic. J Otolaryngol Head Neck Surg. 2020 May 6;49(1):28. PubMed PMID: 32375884.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology - head and neck surgery during the COVID-19 pandemic. AU - Thamboo,Andrew, AU - Lea,Jane, AU - Sommer,Doron D, AU - Sowerby,Leigh, AU - Abdalkhani,Arman, AU - Diamond,Christopher, AU - Ham,Jennifer, AU - Heffernan,Austin, AU - Cai Long,M, AU - Phulka,Jobanjit, AU - Wu,Yu Qi, AU - Yeung,Phillip, AU - Lammers,Marc, Y1 - 2020/05/06/ PY - 2020/04/15/received PY - 2020/04/28/accepted PY - 2020/5/8/entrez PY - 2020/5/8/pubmed PY - 2020/5/10/medline KW - Aerosol KW - Aerosolization KW - COVID-19 KW - Guideline KW - Review SP - 28 EP - 28 JF - Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale JO - J Otolaryngol Head Neck Surg VL - 49 IS - 1 N2 - BACKGROUND: Aerosol generating medical procedures (AGMPs) present risks to health care workers (HCW) due to airborne transmission of pathogens. During the COVID-19 pandemic, it is essential for HCWs to recognize which procedures are potentially aerosolizing so that appropriate infection prevention precautions can be taken. The aim of this literature review was to identify potential AGMPs in Otolaryngology - Head and Neck Surgery and provide evidence-based recommendations. METHODS: A literature search was performed on Medline, Embase and Cochrane Review databases up to April 3, 2020. All titles and abstracts of retrieved studies were evaluated and all studies mentioning potential AGMPs were included for formal review. Full text of included studies were assessed by two reviewers and the quality of the studies was evaluated. Ten categories of potential AGMPs were developed and recommendations were provided for each category. RESULTS: Direct evidence indicates that CO2 laser ablation, the use of high-speed rotating devices, electrocautery and endotracheal suctioning are AGMPs. Indirect evidence indicates that tracheostomy should be considered as potential AGMPs. Nasal endoscopy and nasal packing/epistaxis management can result in droplet transmission, but it is unknown if these procedures also carry the risk of airborne transmission. CONCLUSIONS: During the COVID-19 pandemic, special care should be taken when CO2 lasers, electrocautery and high-speed rotating devices are used in potentially infected tissue. Tracheal procedures like tracheostomy and endotracheal suctioning can also result in airborne transmission via small virus containing aerosols. SN - 1916-0216 UR - https://www.unboundmedicine.com/medline/citation/32375884/Clinical_evidence_based_review_and_recommendations_of_aerosol_generating_medical_procedures_in_otolaryngology___head_and_neck_surgery_during_the_COVID_19_pandemic_ L2 - https://journalotohns.biomedcentral.com/articles/10.1186/s40463-020-00425-6 DB - PRIME DP - Unbound Medicine ER -