Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK.
J Hosp Infect. 2022 Jun;124:13-21. doi: 10.1016/j.jhin.2022.02.021. Epub 2022 Mar 9.
Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence.
To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients.
This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3-10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation.
Aerosol was reliably detected {median 65 [interquartile range (IQR) 39-259] particles/L} above background [median 4.8 (IQR 1-7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0-12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30-75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600-4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300-1826) particles/L, P<0.0001].
Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
开放式吸痰被定义为一种气溶胶产生程序（AGP）。用于清除麻醉期间分泌物的咽喉抽吸术，广泛被认为是一种 AGP。然而，由于缺乏气溶胶和流行病学证据，尚不确定上呼吸道抽吸术是否应被指定为 AGP。
评估在麻醉患者气管插管和拔管期间上呼吸道抽吸术产生气溶胶的相对风险。
本前瞻性环境监测研究在超净手术室环境中进行，用于检测患者（N=19）手术期间插管和拔管序列中（包括上呼吸道抽吸术）的气溶胶浓度。一个光学粒子计数器（粒径 0.3-10μm）在距患者口 20cm 处采样气溶胶。在静脉诱导麻醉和神经肌肉阻滞后，先进行背景记录（基础呼吸、自主咳嗽），再进行 4 次咽喉抽吸：喉镜检查前、插管后、拔管前和拔管后。
在接近患者口的位置进行潮式呼吸采样时，可靠地检测到 65 个 [中位数（IQR）39-259 个/升] 高于背景的气溶胶粒子[中位数 4.8 个（IQR 1-7 个）/升，P<0.0001]。上呼吸道抽吸术产生的气溶胶浓度明显低于基础呼吸时的气溶胶浓度[中位数 6.0 个（IQR 0-12 个）/升，P=0.0007]，且与背景无差异（P>0.99）。在抽吸过程中记录到的气溶胶峰值浓度[中位数 45 个（IQR 30-75 个）/升]远低于自主咳嗽时的峰值浓度[中位数 1520 个（IQR 600-4363 个）/升，P<0.0001]和潮式呼吸时的峰值浓度[中位数 540 个（IQR 300-1826 个）/升，P<0.0001]。
与背景相比，在气道管理期间进行上呼吸道抽吸术并没有导致更高的气溶胶浓度，与呼吸和咳嗽相比，其气溶胶浓度也明显更低。上呼吸道抽吸术不应被指定为高风险的 AGP。
