Simulation and Measurement of Aerosolisation in Different Chest Drainage Systems

Abstract

The aim of the study was to assess the degree of aerosolisation in different chest drainage systems according to different air leak volumes, in a simulated environment. This novel simulation model was designed to produce an air leak by passing air through and agitating a fluorescent fluid. The air leak volume and amount of fluorescent fluid were tested in various combinations and aerosolisation was assessed at 10-minute intervals using the ultraviolet light. The following chest drainage systems were compared: (1) single-chamber chest drainage system, (2) 3-compartment wet-dry suction chest drainage system, (3) digital drainage and monitoring system. The impact of suction (−2 and −4 kPa) in generating aerosolised particles was tested as well. A total number of 187 of 10-minute interval measurements were performed. The single-chamber chest drainage system generated the largest number of aerosolised particles at different air leak volumes and drainage output. The 3-compartment wet-dry suction system and the digital drainage and monitoring system did not generate any identifiable aerosolised particles at any of the air leak or drain output volumes considered. Suction applied to the chest drainage systems did not have an effect on aerosolisation. Aerosol generation in the simulated air-leak model demonstrated the potential risk of SARS-CoV-2 spread in the clinical setting. Full personal protective equipment must be used in patients with an air leak. Single-chamber chest drainage system generates the highest rate of aerosolised particles and it should not be used as an open system in patients with an air leak.

Anesthetic Management for Thoracic Surgery During the COVID-19 Pandemic

“…Many thoracic surgical patients have the requirement for intercostal chest drainage which is connected to a drainage system in the immediate postoperative period. A bubbling chest drain with an ambient air exhaust can generate aerosols [55]. The British Thoracic Society suggests mitigating this risk by constant connection of chest drains to wall suction, use of a digital chest drain system, or use of an anti-viral filter attached to a standard chest drainage system [56].…”

Commentary-Aerosolization From Chest Drainage Systems in Patients With Air Leak: Risk of Viral Spreading in the Hospital and Community

“…This is generally supervised by multiple health care professionals such as nurses and physiotherapists and the patient can get in contact with other patients circulating in the ward. The study from Mustaev and coll 1 support the safety practice to organise this activity in a way to prevent the patient to wear a single chamber system while performing physical activity or mobilising in the ward minimising the risk of viral spreading to other patients and health care professionals.…”

“…The study of Mustaev and coll. 1 contributes to add to the current knowledge about safety of chest drainage systems currently in use in our operative rooms and wards. They were able to demonstrate through a basic laboratory simulation that single chamber systems are at increased risk of generating aerosols in the surrounding atmosphere in the presence of an active air leak.…”

Commentary: Covid 19: Don't Throw Caution to the Wind Nor Air Leak. Use PPE!

“…In this original article, Mustaev and colleagues sought to define the degree of aerosolization from chest tube drainage systems in the context of the COVID-19 pandemic. 2 They conceptualized and developed a novel simulation model for measuring aerosol generation by agitating a fluorescent fluid with different air flow rates. The aerosolized particles were measured under ultraviolet light.…”

“…They concluded that the single chamber chest drainage system is much more likely to generate aerosols than a three-chamber or digital drainage system and therefore, single chambers should not be used in patients with air leak. 2 …”