在临床环境下经鼻内镜器械操作时气溶胶浓度的量化。
Quantification of Aerosol Concentrations During Endonasal Instrumentation in the Clinic Setting.
机构信息
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.
出版信息
Laryngoscope. 2021 May;131(5):E1415-E1421. doi: 10.1002/lary.29122. Epub 2020 Oct 5.
OBJECTIVE
Recent anecdotal reports and cadaveric simulations have described aerosol generation during endonasal instrumentation, highlighting a possible risk for transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) during endoscopic endonasal instrumentation. This study aims to provide a greater understanding of particle generation and exposure risk during endoscopic endonasal instrumentation.
STUDY DESIGN
Prospective quantification of aerosol generation during office-based nasal endoscopy procedures.
METHODS
Using an optical particle sizer, airborne particles concentrations 0.3 to 10 microns in diameter, were measured during 30 nasal endoscopies in the clinic setting. Measurements were taken at time points throughout diagnostic and debridement endoscopies and compared to preprocedure and empty room particle concentrations.
RESULTS
No significant change in airborne particle concentrations was measured during diagnostic nasal endoscopies in patients without the need for debridement. However, significant increases in mean particle concentration compared to preprocedure levels were measured during cold instrumentation at 2,462 particles/foot (95% CI 837 to 4,088; P = .005) and during suction use at 2,973 particle/foot (95% CI 1,419 to 4,529; P = .001). In total, 99.2% of all measured particles were ≤1 μm in diameter.
CONCLUSION
When measured with an optical particle sizer, diagnostic nasal endoscopy with a rigid endoscope is not associated with increased particle aerosolization in patient for whom sinonasal debridement is not needed. In patients needing sinonasal debridement, endonasal cold and suction instrumentation were associated with increased particle aerosolization, with a trend observed during endoscope use prior to tissue manipulation. Endonasal debridement may potentially pose a higher risk for aerosolization and SARS-CoV-2 transmission. Appropriate personal protective equipment use and patient screening are recommended for all office-based endonasal procedures.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E1415-E1421, 2021.
目的
最近有一些轶事报道和尸体模拟研究描述了经鼻内镜手术过程中气溶胶的产生，这突出表明在进行内镜经鼻内镜手术时，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）可能存在传播风险。本研究旨在更深入地了解内镜经鼻内镜手术过程中颗粒的产生和暴露风险。
研究设计
在门诊鼻内窥镜手术过程中对气溶胶生成进行前瞻性量化。
方法
使用光学粒子计数器，在诊所环境下对 30 例鼻内窥镜检查中的直径为 0.3 至 10 微米的空气传播颗粒浓度进行了测量。在诊断性和清创性内窥镜检查过程中以及与术前和空房间颗粒浓度进行了测量。
结果
在无需清创的患者中，在进行诊断性鼻内窥镜检查时，未测量到空气中颗粒浓度的显著变化。然而，在冷器械使用时与术前水平相比，平均颗粒浓度显著增加，为 2,462 个/英尺（95%CI 837 至 4,088；P = 0.005），在使用吸引时为 2,973 个/英尺（95%CI 1,419 至 4,529；P = 0.001）。总的来说，所有测量的颗粒中 99.2%的直径均≤1μm。
结论
当使用光学粒子计数器进行测量时，对于不需要鼻腔鼻窦清创的患者，刚性内窥镜诊断性鼻内窥镜检查不会导致颗粒气溶胶化增加。在需要鼻腔鼻窦清创的患者中，经鼻冷器械和吸引器器械与颗粒气溶胶化增加相关，在进行组织处理之前观察到内窥镜使用时存在趋势。经鼻清创术可能会增加气溶胶化和 SARS-CoV-2 传播的风险。建议对所有门诊经鼻手术都使用适当的个人防护设备和患者筛查。
证据水平
3 级喉镜，131：E1415-E1421，2021。
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