Department of Anaesthesia & Perioperative Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK.
Arup, London, UK.
Br J Anaesth. 2021 Feb;126(2):544-549. doi: 10.1016/j.bja.2020.09.047. Epub 2020 Nov 16.
Hazardous pathogens are spread in either droplets or aerosols produced during aerosol-generating procedures (AGP). Adjuncts minimising exposure of healthcare workers to hazardous pathogens released during AGP may be beneficial. We used state-of-the-art computational fluid dynamics (CFD) modelling to optimise the performance of a custom-designed shield.
We modelled airflow patterns and trajectories of particles (size range 1-500 μm) emitted during a typical cough using CFD (ANSYS Fluent software, Canonsburg, PA, USA), in the presence and absence of a protective shield enclosing the head of a patient. We modelled the effect of different shield designs, suction tube position, and suction flow rate on particle escape from the shield.
Use of the shield prevented escape of 99.1-100% of particles, which were either trapped on the shield walls (16-21%) or extracted via suction (79-82%). At most, 0.9% particles remained floating inside the shield. Suction flow rates (40-160 L min) had no effect on the final location of particles in a closed system. Particle removal from within the shield was optimal when a suction catheter was placed vertically next to the head of the patient. Addition of multiple openings in the shield reduced the purging performance from 99% at 160 L min to 67% at 40 L min.
CFD modelling provides information to guide optimisation of the efficient removal of hazardous pathogens released during AGP from a custom-designed shield. These data are essential to establish before clinical use, pragmatic clinical trials, or both.
危险病原体通过气溶胶生成程序(AGP)产生的飞沫或气溶胶传播。减少 AGP 期间释放的危险病原体暴露的辅助手段可能是有益的。我们使用最先进的计算流体动力学(CFD)模型来优化定制设计的盾牌的性能。
我们使用 CFD(美国宾夕法尼亚州坎农斯堡的 ANSYS Fluent 软件)模拟了在典型咳嗽过程中产生的气流模式和颗粒(1-500μm 粒径范围)的轨迹,同时存在和不存在包围患者头部的保护罩。我们模拟了不同屏蔽设计、吸气管位置和抽吸流量对颗粒从屏蔽中逸出的影响。
使用屏蔽可防止 99.1-100%的颗粒逸出,这些颗粒要么被困在屏蔽壁上(16-21%),要么通过抽吸(79-82%)提取。最多有 0.9%的颗粒仍漂浮在屏蔽内。在封闭系统中,抽吸流量(40-160 L min)对颗粒的最终位置没有影响。当将抽吸导管垂直放置在患者头部旁边时,从屏蔽内去除颗粒的效果最佳。在屏蔽上增加多个开口会将清除效率从 160 L min 时的 99%降低到 40 L min 时的 67%。
CFD 模型提供了指导从定制设计的盾牌中有效去除 AGP 期间释放的危险病原体的优化信息。在进行临床使用、实用临床试验或两者之前,都需要建立这些数据。