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    Aerosolisation during tracheal intubation and extubation in an operating theatre setting

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    Author
    Dhillon, RS; Rowin, WA; Humphries, RS; Kevin, K; Ward, JD; Phan, TD; Nguyen, LV; Wynne, DD; Scott, DA
    Date
    2020-11-03
    Source Title
    Anaesthesia
    Publisher
    WILEY
    University of Melbourne Author/s
    Abu Rowin, Wagih; Hutchins, Nicholas
    Affiliation
    Mechanical Engineering
    Metadata
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    Document Type
    Journal Article
    Citations
    Dhillon, R. S., Rowin, W. A., Humphries, R. S., Kevin, K., Ward, J. D., Phan, T. D., Nguyen, L. V., Wynne, D. D. & Scott, D. A. (2020). Aerosolisation during tracheal intubation and extubation in an operating theatre setting. ANAESTHESIA, https://doi.org/10.1111/anae.15301.
    Access Status
    Access this item via the Open Access location
    URI
    http://hdl.handle.net/11343/254612
    DOI
    10.1111/anae.15301
    Open Access URL
    https://europepmc.org/articles/PMC7675280?pdf=render
    Abstract
    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.

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