Assessment of the potential for pathogen dispersal during high-flow nasal therapy

Kotoda, Masakazu; Hishiyama, Sohei; Mitsui, Kazuha; Tanikawa, T.; Morikawa, S; Takamino, Ayasa; Matsukawa, Takashi

doi:10.1016/j.jhin.2019.11.010

Cited by 61 publications

(64 citation statements)

References 10 publications

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“…During the 2003 SARS outbreak, there were reports of significant transmission secondary to non‐invasive ventilation . Manikin studies suggest that dispersal of liquid from high flow nasal oxygen at 60 L/min is minimal and significantly less than that caused by coughing and sneezing, providing that nasal cannulae are well fitted . Nevertheless, the risk to health care workers of aerosolisation remains unclear and will depend on many variables, including flow rates, ventilator pressures, patient coughing and cooperation, and the quality and fit of staff personal protective equipment (PPE).…”

Section: Non‐invasive Ventilation and High Flow Nasal Oxygen Therapymentioning

confidence: 99%

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

Brewster

Chrimes²,

B.T.³

et al. 2020

Medical Journal of Australia

361

485

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Introduction This statement was planned on 11 March 2020 to provide clinical guidance and aid staff preparation for the coronavirus disease 2019 (COVID‐19) pandemic in Australia and New Zealand. It has been widely endorsed by relevant specialty colleges and societies. Main recommendations Generic guidelines exist for the intubation of different patient groups, as do resources to facilitate airway rescue and transition to the “can't intubate, can't oxygenate” scenario. They should be followed where they do not contradict our specific recommendations for the COVID‐19 patient group. Consideration should be given to using a checklist that has been specifically modified for the COVID‐19 patient group. Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non‐invasive ventilation. Significant institutional preparation is required to optimise staff and patient safety in preparing for the airway management of the COVID‐19 patient group. The principles for airway management should be the same for all patients with COVID‐19 (asymptomatic, mild or critically unwell). Safe, simple, familiar, reliable and robust practices should be adopted for all episodes of airway management for patients with COVID‐19. Changes in management as a result of this statement Airway clinicians in Australia and New Zealand should now already be involved in regular intensive training for the airway management of the COVID‐19 patient group. This training should focus on the principles of early intervention, meticulous planning, vigilant infection control, efficient processes, clear communication and standardised practice.

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Section: Non‐invasive Ventilation and High Flow Nasal Oxygen Therapymentioning

confidence: 99%

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

Brewster

Chrimes²,

B.T.³

et al. 2020

Medical Journal of Australia

361

485

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“…As such, the ability to limit the overall environmental exposure becomes important. Although modeling of liquid and bacterial pathogen dispersal demonstrated that high flow therapy limited the dispersion to the area proximate to the face and cannula, the issue of partial contamination remains concerning 27. Particle sizes of droplets or aerosolized infectious pathogens can directly have bearing on transmission distance.…”

mentioning

confidence: 99%

Reducing aerosol dispersion by high flow therapy in COVID‐19: High resolution computational fluid dynamics simulations of particle behavior during high velocity nasal insufflation with a simple surgical mask

et al. 2020

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Objective All respiratory care represents some risk of becoming an aerosol‐generating procedure (AGP) during COVID‐19 patient management. Personal protective equipment (PPE) and environmental control/engineering is advised. High velocity nasal insufflation (HVNI) and high flow nasal cannula (HFNC) deliver high flow oxygen (HFO) therapy, established as a competent means of supporting oxygenation for acute respiratory distress patients, including that precipitated by COVID‐19. Although unlikely to present a disproportionate particle dispersal risk, AGP from HFO continues to be a concern. Previously, we published a preliminary model. Here, we present a subsequent highresolution simulation (higher complexity/reliability) to provide a more accurate and precise particle characterization on the effect of surgical masks on patients during HVNI, low‐flow oxygen therapy (LFO2), and tidal breathing. Methods This in silico modeling study of HVNI, LFO2, and tidal breathing presents ANSYS fluent computational fluid dynamics simulations that evaluate the effect of Type I surgical mask use over patient face on particle/droplet behavior. Results This in silico modeling simulation study of HVNI (40 L min−1) with a simulated surgical mask suggests 88.8% capture of exhaled particulate mass in the mask, compared to 77.4% in LFO2 (6 L min−1) capture, with particle distribution escaping to the room (> 1 m from face) lower for HVNI+Mask versus LFO2+Mask (8.23% vs 17.2%). The overwhelming proportion of particulate escape was associated with mask‐fit designed model gaps. Particle dispersion was associated with lower velocity. Conclusions These simulations suggest employing a surgical mask over the HVNI interface may be useful in reduction of particulate mass distribution associated with AGPs.

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“…There is no currently published evidence that HFNO is a risk factor for nosocomial transmission of respiratory pathogens 27‐30 . During the 2003 Toronto SARS‐CoV outbreak, HFNO was not found to be a risk factor for transmission to healthcare workers 29 .…”

Section: Intermediate Therapiesmentioning

confidence: 98%

Respiratory support for adult patients with COVID‐19

Pavlov²,

et al. 2020

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The COVID‐19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non‐invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID‐19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol‐generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non‐rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non‐invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi‐organ failure, or acute respiratory distress syndrome (ARDS).

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Assessment of the potential for pathogen dispersal during high-flow nasal therapy

Cited by 61 publications

References 10 publications

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group

Reducing aerosol dispersion by high flow therapy in COVID‐19: High resolution computational fluid dynamics simulations of particle behavior during high velocity nasal insufflation with a simple surgical mask

Respiratory support for adult patients with COVID‐19

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