手术室喉科学操作中的气溶胶生成。
Aerosol Generation During Laryngology Procedures in the Operating Room.
机构信息
Tina and Rick Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A.
University of Southern California, Keck School of Medicine, Los Angeles, California, U.S.A.
出版信息
Laryngoscope. 2021 Dec;131(12):2759-2765. doi: 10.1002/lary.29729. Epub 2021 Jul 2.
OBJECTIVE
Severe acute respiratory syndrome coronavirus-2 spreads through respiratory fluids. We aim to quantify aerosolized particles during laryngology procedures to understand their potential for transmission of infectious aerosol-based diseases.
STUDY DESIGN
Prospective quantification of aerosol generation.
METHODS
Airborne particles (0.3-25 μm in diameter) were measured during live-patient laryngology surgeries using an optical particle counter positioned 60 cm from the oral cavity to the surgeon's left. Measurements taken during the procedures were compared to baseline concentrations recorded immediately before each procedure. Procedures included direct laryngoscopy with general endotracheal anesthesia (GETA), direct laryngoscopy with jet ventilation, and carbon dioxide (CO ) laser use with or without jet ventilation, all utilizing intermittent suction.
RESULTS
Greater than 99% of measured particles were 0.3 to 1.0 μm in diameter. Compared to baseline, direct laryngoscopy was associated with a significant 6.71% increase in cumulative particles, primarily 0.3 to 1.0 μm particles (P < .0001). 1.0 to 25 μm particles significantly decreased (P < .001). Jet ventilation was not associated with a significant change in cumulative particles; when analyzing differential particle sizes, only 10 to 25 μm particles exhibited a significant increase compared to baseline (+42.40%, P = .002). Significant increases in cumulative particles were recorded during CO laser use (+14.70%, P < .0001), specifically in 0.3 to 2.5 μm particles. Overall, there was no difference when comparing CO laser use during jet ventilation versus GETA.
CONCLUSIONS
CO laser use during laryngology surgery is associated with significant increases in airborne particles. Although direct laryngoscopy with GETA is associated with slight increases in particles, jet ventilation overall does not increase particle aerosolization.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:2759-2765, 2021.
目的
严重急性呼吸综合征冠状病毒-2 通过呼吸道飞沫传播。我们旨在量化喉科学手术过程中产生的气溶胶颗粒，以了解它们传播传染性气溶胶疾病的潜力。
研究设计
气溶胶生成的前瞻性量化。
方法
使用位于距口腔 60 厘米至外科医生左侧的光学粒子计数器，对活体患者喉科学手术过程中的空气传播颗粒（直径 0.3-25μm）进行测量。将手术过程中测量到的数值与每次手术前立即记录的基线浓度进行比较。手术包括在全身气管内麻醉（GETA）下进行直接喉镜检查、喷射通气下进行直接喉镜检查、以及有或无喷射通气的二氧化碳（CO ）激光使用，所有这些都利用间歇性抽吸。
结果
超过 99%的测量颗粒直径在 0.3 至 1.0μm 之间。与基线相比，直接喉镜检查导致累积颗粒显著增加 6.71%，主要是 0.3 至 1.0μm 颗粒（P<.0001）。1.0 至 25μm 颗粒显著减少（P<.001）。喷射通气与累积颗粒无显著变化相关；当分析差分颗粒尺寸时，与基线相比，只有 10 至 25μm 颗粒显示出显著增加（+42.40%，P=.002）。CO 激光使用时，累积颗粒显著增加（+14.70%，P<.0001），特别是在 0.3 至 2.5μm 颗粒中。总体而言，CO 激光在喷射通气与 GETA 中的使用比较没有差异。
结论
喉科学手术中 CO 激光的使用与空气中颗粒显著增加有关。尽管在 GETA 下进行直接喉镜检查会导致颗粒略有增加，但喷射通气总体上不会增加颗粒气溶胶化。
证据水平
3 级喉镜，131：2759-2765，2021。
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