The Aerosol-Generating Effect Among Noninvasive Positive Pressure Ventilation, High-Flow Nasal Cannula, Nonrebreather Mask, Nasal Cannula, and Ventilator-Assisted Preoxygenation

Hung, Tzu-Yao; Chen, Wei‐Lun; Su, Yung-Cheng; Wu, Chih-Chieh; Wang, Chung-Chun; Chen, Hsin-Ling; Hu, Shih−Cheng; Lin, Tee

doi:10.1016/j.annemergmed.2022.02.015

Cited by 5 publications

(12 citation statements)

References 35 publications

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“…In contrast, in Hung's study of HFNC with flow rates of 70 L/min, the maximum dispersion was 1.00 ± 0.01 m in length and 0.57 ± 0.02 m in width. This finding suggests that Hui's study may have observed a shorter period than both the 3-min period in Hung's study and the 10-min period in our study 29 . Overall, the aerosol dispersion distance of HFNC remained the largest among the non-invasive oxygenation devices studied [27][28][29] .…”

Section: Discussioncontrasting

confidence: 45%

“…This finding suggests that Hui's study may have observed a shorter period than both the 3-min period in Hung's study and the 10-min period in our study 29 . Overall, the aerosol dispersion distance of HFNC remained the largest among the non-invasive oxygenation devices studied [27][28][29] . HFNC involves an air/oxygen blender, active humidifier, single heated tube, and nasal cannula.…”

Section: Discussioncontrasting

confidence: 45%

“…Numerous studies have documented aerosol dispersions from various oxygen-delivery devices [27][28][29] . Hung et al 29 reported maximum aerosol dispersion at different minute ventilation settings recorded within 3 min: 51.49 ± 19.47 cm for the reference group (no oxygen device), 64.31 ± 14.39 cm for HFNC 30 L/min, 67.09 ± 12.74 cm for HFNC 70 L/min, 85.55 ± 7.28 cm for NCO 15 L/min, and 63.08 ± 15.33 cm for NRM 15 L/ min at 20 L/min. Hui et al 27 also reported aerosol-dispersion distances for NCO at 1, 3, and 5 L/min of < 42 cm, while those for NRM at 6, 8, 10, and 12 L/min were < 10 cm.…”

Section: Discussionmentioning

confidence: 99%

“…3 ). Hung et al 29 reported that aerosol concentration during NRM at 15 L/min was higher in the head area vs. the foot and trunk areas in a 3-min observation period; owing to the holes on the upper part of the mask, the particle concentration in the head area rapidly increased. Conversely, this study was conducted over 10 min, which could explain this difference.…”

Section: Discussionmentioning

confidence: 99%

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Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy

Wu,

Chen,

Tseng

et al. 2023

Sci Rep

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This study evaluated the aerosol exposure risks while using common noninvasive oxygenation devices. A simulated mannequin was designed to breathe at a minute ventilation of 20 L/min and used the following oxygen-therapy devices: nasal cannula oxygenation (NCO) at 4 and 15 L/min, nonrebreathing mask (NRM) at 15 L/min, simple mask at 6 L/min, combination of NCO at 15 L/min and NRM at 15 L/min, high-flow nasal cannula (HFNC) at 50 L/min, and flush rate NRM. Two-dimension of the dispersion distance and the aerosol concentrations were measured at head, trunk, and foot around the mannequin for over 10 min. HFNC and flush-rate NRM yielded the longest dispersion distance and highest aerosol concentrations over the three sites of the mannequin than the other oxygenation devices and should use with caution. For flow rates of < 15 L/min, oxygenation devices with mask-like effects, such as NRM or NCO with NRM, decreased aerosol dispersion more effectively than NCO alone or a simple mask. In the upright position, the foot area exhibited the highest aerosol concentration regardless of the oxygenation device than the head–trunk areas of the mannequin. Healthcare workers should be alert even at the foot side of the patient while administering oxygenation therapy.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy

Wu,

Chen,

Tseng

et al. 2023

Sci Rep

Self Cite

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“…COVID is most commonly transmitted through droplets, aerosols (diameter of ≤ 5 µm), and fomites 15 – 17 . Several essential procedures during outpatient and inpatient resuscitation are considered aerosol generating procedures: chest compression, pre-oxygenation, and manual ventilation 16 , 18 , 19 .…”

Section: Introductionmentioning

confidence: 99%

A comparative analysis of aerosol exposure and prevention strategies in bystander, pre-hospital, and inpatient cardiopulmonary resuscitation using simulation manikins

Hung

Wen

et al. 2023

Sci Rep

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To evaluate aerosol exposure risk and prevention strategies during bystander, pre-hospital, and inpatient cardiopulmonary resuscitation (CPR). This study compared hands-only CPR, CPR with a surgical or N95 mask, and CPR with a non-rebreather mask at 15 L/min. 30:2 compression–ventilation ratio CPR was tested with face-mask ventilation (FMV), FMV with a high efficiency particulate air (HEPA) filter; supraglottic airway (SGA), SGA with a surgical mask, SGA with a HEPA filter, or SGA with both. Continuous CPR was tested with an endotracheal tube (ET), ET with a surgical mask, a HEPA filter, or both. Aerosol concentration at the head, trunk, and feet of the mannequin were measured to evaluate exposure to CPR personnel. Hands-only CPR with a surgical or N95 face mask coverings and ET tube ventilation CPR with filters showed the lowest aerosol exposure among all study groups, including CPR with NRM oxygenation, FMV, and SGA ventilation. NRM had a mask effect and reduced aerosol exposure at the head, trunk, and feet of the mannequin. FMV with filters during 30:2 CPR reduced aerosol exposure at the head and trunk, but increased at the feet of the mannequin. A tightly-sealed SGA when used with a HEPA filter, reduced aerosol exposure by 21.00–63.14% compared with a loose-fitting one. Hands-only CPR with a proper fit surgical or N95 face mask coverings is as safe as ET tube ventilation CPR with filters, compared with CPR with NRM, FMV, and SGA. FMV or tight-sealed SGA ventilation with filters prolonged the duration to achieve estimated infective dose of SARS-CoV-2 2.4–2.5 times longer than hands-on CPR only. However, a loose-fitting SGA is not protective at all to chest compressor or health workers standing at the foot side of the victim, so should be used with caution even when using with HEPA filters.

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141 Comparing Aerosol Exposure and Prevention Strategies During Bystander, Pre-hospital, and Inpatient Cardiopulmonary Resuscitation

Li,

2023

Annals of Emergency Medicine

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The Aerosol-Generating Effect Among Noninvasive Positive Pressure Ventilation, High-Flow Nasal Cannula, Nonrebreather Mask, Nasal Cannula, and Ventilator-Assisted Preoxygenation

Cited by 5 publications

References 35 publications

Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy

Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy

A comparative analysis of aerosol exposure and prevention strategies in bystander, pre-hospital, and inpatient cardiopulmonary resuscitation using simulation manikins

141 Comparing Aerosol Exposure and Prevention Strategies During Bystander, Pre-hospital, and Inpatient Cardiopulmonary Resuscitation

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