Mechanical Engineering - Research Publications

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Author: Hutchins, Nicholas × Author: Kevin, Kevin × Start date: 2020 × End date: 2021 ×

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    Aerosolisation in endonasal endoscopic pituitary surgery
    Dhillon, RS ; Nguyen, L ; Abu Rowin, W ; Humphries, RS ; Kevin, K ; Ward, JD ; Yule, A ; Phan, TD ; Zhao, YC ; Wynne, D ; McNeill, PM ; Hutchins, N ; Scott, DA (SPRINGER, 2021-08)
    PURPOSE: To determine the particle size, concentration, airborne duration and spread during endoscopic endonasal pituitary surgery in actual patients in a theatre setting. METHODS: This observational study recruited a convenience sample of three patients. Procedures were performed in a positive pressure operating room. Particle image velocimetry and spectrometry with air sampling were used for aerosol detection. RESULTS: Intubation and extubation generated small particles (< 5 µm) in mean concentrations 12 times greater than background noise (p < 0.001). The mean particle concentrations during endonasal access were 4.5 times greater than background (p = 0.01). Particles were typically large (> 75 µm), remained airborne for up to 10 s and travelled up to 1.1 m. Use of a microdebrider generated mean aerosol concentrations 18 times above baseline (p = 0.005). High-speed drilling did not produce aerosols greater than baseline. Pituitary tumour resection generated mean aerosol concentrations less than background (p = 0.18). Surgical drape removal generated small and large particles in mean concentrations 6.4 times greater than background (p < 0.001). CONCLUSION: Intubation and extubation generate large amounts of small particles that remain suspended in air for long durations and disperse through theatre. Endonasal access and pituitary tumour resection generate smaller concentrations of larger particles which are airborne for shorter periods and travel shorter distances.
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    Nasal preparation with local anesthetic should be considered an aerosol-generating procedure
    Dhillon, RS ; Nguyen, LV ; Rowin, WA ; Humphries, RS ; Kevin, K ; Ward, JD ; Yule, A ; Phan, TD ; Wynne, D ; McNeill, PM ; Hutchins, N ; Scott, DA ; Zhao, YC (WILEY, 2021-06)
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    Aerosolisation during tracheal intubation and extubation in an operating theatre setting
    Dhillon, RS ; Rowin, WA ; Humphries, RS ; Kevin, K ; Ward, JD ; Phan, TD ; Nguyen, LV ; Wynne, DD ; Scott, DA (WILEY, 2021-02)
    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.