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Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department

OBJECTIVES: Health care workers experience an uncertain risk of aerosol exposure during patient oxygenation. To improve our understanding of these risks, we sought to measure aerosol production during various approaches to oxygenation in healthy volunteers in an emergency department. METHODS: This w...

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Autores principales: Pearce, Emily, Campen, Matthew J., Baca, Justin T., Blewett, John P., Femling, Jon, Hanson, David T., Kraai, Erik, Muttil, Pavan, Wolf, Blair, Lauria, Michael, Braude, Darren
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926006/
https://www.ncbi.nlm.nih.gov/pubmed/33718924
http://dx.doi.org/10.1002/emp2.12390
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author Pearce, Emily
Campen, Matthew J.
Baca, Justin T.
Blewett, John P.
Femling, Jon
Hanson, David T.
Kraai, Erik
Muttil, Pavan
Wolf, Blair
Lauria, Michael
Braude, Darren
author_facet Pearce, Emily
Campen, Matthew J.
Baca, Justin T.
Blewett, John P.
Femling, Jon
Hanson, David T.
Kraai, Erik
Muttil, Pavan
Wolf, Blair
Lauria, Michael
Braude, Darren
author_sort Pearce, Emily
collection PubMed
description OBJECTIVES: Health care workers experience an uncertain risk of aerosol exposure during patient oxygenation. To improve our understanding of these risks, we sought to measure aerosol production during various approaches to oxygenation in healthy volunteers in an emergency department. METHODS: This was a prospective study conducted in an empty patient room in an academic ED. The room was 10 ft. long x 10 ft. wide x 9 ft. tall (total volume 900 ft(3)) with positive pressure airflow (1 complete turnover of air every 10 minutes). Five oxygenation conditions were used: humidified high‐flow nasal cannula (HFNC) at 3 flow rates [15, 30, and 60 liters per minute (LPM)], non‐rebreather mask (NRB) at 1 flow rate (15 LPM), and closed‐circuit continuous positive airway pressure (CPAP) using the ED ventilator; in all cases a simple procedural mask was used. The NRB and HFNC at 30 LPM maneuvers were also repeated without the procedural mask, and CPAP was applied both with and without a filter. Each subject then sequentially underwent 8 total oxygenation conditions, always in the same order. Each oxygenation condition was performed with the participant on a standard ED bed. Particles were measured by laser aerosol spectrometer, with the detector sampling port positioned directly over the center of the bed, 0.35 meters away and at a 45‐degree angle from the subject's mouth. Each approach to oxygenation was performed for 10 minutes, followed by a 20‐minute room washout (≈ 2 complete room air turnovers). Particle counts were summated for 2 size ranges (150–300 nm and 0.5–2.0 μm) and compared before, during, and after each of the 8 oxygenation conditions. RESULTS: Eight adult subjects were enrolled (mean age 42 years, body mass index 25). All subjects completed 8 oxygenation procedures (64 total). Mean particle counts per minute across all oxygenation procedures was 379 ± 112 (mean ± SD) for smaller aerosols (150–300 nm) and 9.3 ± 4.6 for larger aerosols (0.5–2.0 μm). HFNC exhibited a flow‐dependent increase in particulate matter (PM) generation—at 60 LPM, HFNC had a substantial generation of small (55% increase) and large particles (70% increase) compared to 15 LPM. CPAP was associated with lowered small and large particle generation (≈ 10–15% below baseline for both sizes of PM). A patient mask limited particle generation with the NRB, where it was associated with a reduction in small and large particulates (average 40% and 20% lower, respectively). CONCLUSION: Among 3 standard oxygenation procedures, higher flow rates generally were associated with greater production of both small and large aerosols. A patient mask lowered aerosol counts in the NRB only. Protocol development for oxygenation application should consider these factors to increase health care worker safety.
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spelling pubmed-79260062021-03-12 Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department Pearce, Emily Campen, Matthew J. Baca, Justin T. Blewett, John P. Femling, Jon Hanson, David T. Kraai, Erik Muttil, Pavan Wolf, Blair Lauria, Michael Braude, Darren J Am Coll Emerg Physicians Open Airway OBJECTIVES: Health care workers experience an uncertain risk of aerosol exposure during patient oxygenation. To improve our understanding of these risks, we sought to measure aerosol production during various approaches to oxygenation in healthy volunteers in an emergency department. METHODS: This was a prospective study conducted in an empty patient room in an academic ED. The room was 10 ft. long x 10 ft. wide x 9 ft. tall (total volume 900 ft(3)) with positive pressure airflow (1 complete turnover of air every 10 minutes). Five oxygenation conditions were used: humidified high‐flow nasal cannula (HFNC) at 3 flow rates [15, 30, and 60 liters per minute (LPM)], non‐rebreather mask (NRB) at 1 flow rate (15 LPM), and closed‐circuit continuous positive airway pressure (CPAP) using the ED ventilator; in all cases a simple procedural mask was used. The NRB and HFNC at 30 LPM maneuvers were also repeated without the procedural mask, and CPAP was applied both with and without a filter. Each subject then sequentially underwent 8 total oxygenation conditions, always in the same order. Each oxygenation condition was performed with the participant on a standard ED bed. Particles were measured by laser aerosol spectrometer, with the detector sampling port positioned directly over the center of the bed, 0.35 meters away and at a 45‐degree angle from the subject's mouth. Each approach to oxygenation was performed for 10 minutes, followed by a 20‐minute room washout (≈ 2 complete room air turnovers). Particle counts were summated for 2 size ranges (150–300 nm and 0.5–2.0 μm) and compared before, during, and after each of the 8 oxygenation conditions. RESULTS: Eight adult subjects were enrolled (mean age 42 years, body mass index 25). All subjects completed 8 oxygenation procedures (64 total). Mean particle counts per minute across all oxygenation procedures was 379 ± 112 (mean ± SD) for smaller aerosols (150–300 nm) and 9.3 ± 4.6 for larger aerosols (0.5–2.0 μm). HFNC exhibited a flow‐dependent increase in particulate matter (PM) generation—at 60 LPM, HFNC had a substantial generation of small (55% increase) and large particles (70% increase) compared to 15 LPM. CPAP was associated with lowered small and large particle generation (≈ 10–15% below baseline for both sizes of PM). A patient mask limited particle generation with the NRB, where it was associated with a reduction in small and large particulates (average 40% and 20% lower, respectively). CONCLUSION: Among 3 standard oxygenation procedures, higher flow rates generally were associated with greater production of both small and large aerosols. A patient mask lowered aerosol counts in the NRB only. Protocol development for oxygenation application should consider these factors to increase health care worker safety. John Wiley and Sons Inc. 2021-03-02 /pmc/articles/PMC7926006/ /pubmed/33718924 http://dx.doi.org/10.1002/emp2.12390 Text en © 2021 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Airway
Pearce, Emily
Campen, Matthew J.
Baca, Justin T.
Blewett, John P.
Femling, Jon
Hanson, David T.
Kraai, Erik
Muttil, Pavan
Wolf, Blair
Lauria, Michael
Braude, Darren
Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
title Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
title_full Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
title_fullStr Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
title_full_unstemmed Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
title_short Aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
title_sort aerosol generation with various approaches to oxygenation in healthy volunteers in the emergency department
topic Airway
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7926006/
https://www.ncbi.nlm.nih.gov/pubmed/33718924
http://dx.doi.org/10.1002/emp2.12390
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