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Aerosolization During Common Ventilation Scenarios.
Otolaryngol Head Neck Surg. 2020 10; 163(4):702-704.OH

Abstract

Otolaryngologists are at increased risk for exposure to suspected aerosol-generating procedures during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In the present study, we sought to quantify differences in aerosol generation during common ventilation scenarios. We performed a series of 30-second ventilation experiments on porcine larynx-trachea-lung specimens. We used an optical particle sizer to quantify the number of 1- to 10-µm particles observed per 30-second period (PP30). No significant aerosols were observed with ventilation of intubated specimens (10.8 ± 2.4 PP30 vs background 9.5 ± 2.1, P = 1.0000). Simulated coughing through a tracheostomy produced 53.5 ± 25.2 PP30, significantly more than background (P = .0121) and ventilation of an intubated specimen (P = .0401). These data suggest that undisturbed ventilation and thus intubation without stimulation or coughing may be safer than believed. Coughing increases aerosol production, particularly via tracheostomy. Otolaryngologists who frequently manage patient airways and perform tracheostomy are at increased risk for aerosol exposure and require appropriate personal protective equipment, especially during the ongoing COVID-19 pandemic.

Authors+Show Affiliations

Massachusetts Eye and Ear, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA. Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA.Massachusetts Eye and Ear, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA. Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA.Massachusetts Eye and Ear, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA.Massachusetts Eye and Ear, Department of Anesthesiology, Boston, Massachusetts, USA. Harvard Medical School, Department of Anesthesiology, Boston, Massachusetts, USA.Massachusetts Eye and Ear, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA. Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA.Massachusetts Eye and Ear, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA. Harvard Medical School, Department of Otolaryngology-Head and Neck Surgery, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32539661

Citation

Xiao, Roy, et al. "Aerosolization During Common Ventilation Scenarios." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 163, no. 4, 2020, pp. 702-704.
Xiao R, Workman AD, Puka E, et al. Aerosolization During Common Ventilation Scenarios. Otolaryngol Head Neck Surg. 2020;163(4):702-704.
Xiao, R., Workman, A. D., Puka, E., Juang, J., Naunheim, M. R., & Song, P. C. (2020). Aerosolization During Common Ventilation Scenarios. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 163(4), 702-704. https://doi.org/10.1177/0194599820933595
Xiao R, et al. Aerosolization During Common Ventilation Scenarios. Otolaryngol Head Neck Surg. 2020;163(4):702-704. PubMed PMID: 32539661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aerosolization During Common Ventilation Scenarios. AU - Xiao,Roy, AU - Workman,Alan D, AU - Puka,Elefteria, AU - Juang,Jeremy, AU - Naunheim,Matthew R, AU - Song,Phillip C, Y1 - 2020/06/16/ PY - 2020/6/17/pubmed PY - 2020/10/21/medline PY - 2020/6/17/entrez KW - COVID-19 KW - aerosol KW - cough KW - intubation KW - tracheostomy KW - ventilation SP - 702 EP - 704 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 163 IS - 4 N2 - Otolaryngologists are at increased risk for exposure to suspected aerosol-generating procedures during the ongoing coronavirus disease 2019 (COVID-19) pandemic. In the present study, we sought to quantify differences in aerosol generation during common ventilation scenarios. We performed a series of 30-second ventilation experiments on porcine larynx-trachea-lung specimens. We used an optical particle sizer to quantify the number of 1- to 10-µm particles observed per 30-second period (PP30). No significant aerosols were observed with ventilation of intubated specimens (10.8 ± 2.4 PP30 vs background 9.5 ± 2.1, P = 1.0000). Simulated coughing through a tracheostomy produced 53.5 ± 25.2 PP30, significantly more than background (P = .0121) and ventilation of an intubated specimen (P = .0401). These data suggest that undisturbed ventilation and thus intubation without stimulation or coughing may be safer than believed. Coughing increases aerosol production, particularly via tracheostomy. Otolaryngologists who frequently manage patient airways and perform tracheostomy are at increased risk for aerosol exposure and require appropriate personal protective equipment, especially during the ongoing COVID-19 pandemic. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/32539661/Aerosolization_During_Common_Ventilation_Scenarios_ L2 - https://journals.sagepub.com/doi/10.1177/0194599820933595?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -