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Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis

IMPORTANCE: Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. OBJECTIVE: To evaluate the current evidence that high-flow nasal oxygen and no...

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Autores principales: Zhang, Madeline X., Lilien, Thijs A., van Etten-Jamaludin, Faridi S., Fraenkel, Carl-Johan, Bonn, Daniel, Vlaar, Alexander P. J., Löndahl, Jakob, Klompas, Michael, Bem, Reinout A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568354/
https://www.ncbi.nlm.nih.gov/pubmed/37819660
http://dx.doi.org/10.1001/jamanetworkopen.2023.37258
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author Zhang, Madeline X.
Lilien, Thijs A.
van Etten-Jamaludin, Faridi S.
Fraenkel, Carl-Johan
Bonn, Daniel
Vlaar, Alexander P. J.
Löndahl, Jakob
Klompas, Michael
Bem, Reinout A.
author_facet Zhang, Madeline X.
Lilien, Thijs A.
van Etten-Jamaludin, Faridi S.
Fraenkel, Carl-Johan
Bonn, Daniel
Vlaar, Alexander P. J.
Löndahl, Jakob
Klompas, Michael
Bem, Reinout A.
author_sort Zhang, Madeline X.
collection PubMed
description IMPORTANCE: Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. OBJECTIVE: To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. DATA SOURCES: A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. STUDY SELECTION: Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. DATA EXTRACTION AND SYNTHESIS: Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. MAIN OUTCOMES AND MEASURES: The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. RESULTS: Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.
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spelling pubmed-105683542023-10-13 Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis Zhang, Madeline X. Lilien, Thijs A. van Etten-Jamaludin, Faridi S. Fraenkel, Carl-Johan Bonn, Daniel Vlaar, Alexander P. J. Löndahl, Jakob Klompas, Michael Bem, Reinout A. JAMA Netw Open Original Investigation IMPORTANCE: Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. OBJECTIVE: To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. DATA SOURCES: A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. STUDY SELECTION: Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. DATA EXTRACTION AND SYNTHESIS: Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. MAIN OUTCOMES AND MEASURES: The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. RESULTS: Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities. American Medical Association 2023-10-11 /pmc/articles/PMC10568354/ /pubmed/37819660 http://dx.doi.org/10.1001/jamanetworkopen.2023.37258 Text en Copyright 2023 Zhang MX et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Zhang, Madeline X.
Lilien, Thijs A.
van Etten-Jamaludin, Faridi S.
Fraenkel, Carl-Johan
Bonn, Daniel
Vlaar, Alexander P. J.
Löndahl, Jakob
Klompas, Michael
Bem, Reinout A.
Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis
title Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis
title_full Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis
title_fullStr Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis
title_full_unstemmed Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis
title_short Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis
title_sort generation of aerosols by noninvasive respiratory support modalities: a systematic review and meta-analysis
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10568354/
https://www.ncbi.nlm.nih.gov/pubmed/37819660
http://dx.doi.org/10.1001/jamanetworkopen.2023.37258
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