Sayahi Tofigh, Workman Alan D, Kelly Kerry E, Ardon-Dryer Karin, Presto Albert A, Bleier Benjamin S
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2023 Mar;168(3):506-513. doi: 10.1177/01945998221099028. Epub 2023 Jan 28.
Airborne aerosol transmission, an established mechanism of SARS-CoV-2 spread, has been successfully mitigated in the health care setting through the adoption of universal masking. Upper airway endoscopy, however, requires direct access to the face, thereby potentially exposing the clinic environment to infectious particles. This study quantifies aerosol production during rigid nasal endoscopy (RNE) and RNE with debridement (RNED) as compared with intubation, a posited gold standard aerosol-generating procedure.
Prospective cross-sectional study.
Subspecialty single-center clinic and surgical study.
Three aerosol detectors (NANOSCAN-3910, OPS-3330, and APS-3321) with a particle size sensitivity of 10 to 20,000 nm were utilized to detect particulate production during the clinical care of 209 patients undergoing RNE/RNED and 25 patients undergoing intubation.
RNE and RNED produced statistically significant particles over baseline in 29.3% and 51.0% of subjects (P = .003-.049 and .002-.047, respectively). Intubation produced statistically significant particles in 31.2% (P = .001-.015). The mean ± SD particle diameter in all tests was 69.9 ± 10.5 nm with 99.7% <300 nm. There were no statistical differences in particle production among RNE, RNED, and intubation. The presence of concomitant cough, sneeze, or prolonged speech similarly did not significantly affect particle production during any procedure.
Instrumentation of nasal airway produces airborne aerosols to a similar degree of those seen during intubation, independent of reactive patient behaviors such as cough or sneeze. These data suggest that an improved understanding is necessary of both the definition of an aerosol-generating procedure and the functional consequences of procedural aerosol generation in clinical settings.
空气传播气溶胶是严重急性呼吸综合征冠状病毒2（SARS-CoV-2）传播的一种既定机制，在医疗环境中通过采用普遍佩戴口罩已成功减轻其传播。然而，上呼吸道内镜检查需要直接接触面部，从而可能使临床环境暴露于感染性颗粒中。本研究将硬性鼻内镜检查（RNE）和带清创术的硬性鼻内镜检查（RNED）期间产生的气溶胶与插管（一种假定的产生气溶胶的金标准操作）进行比较，对气溶胶产生情况进行量化。
前瞻性横断面研究。
亚专科单中心诊所及外科研究。
使用3个粒径敏感度为10至20000纳米的气溶胶探测器（NANOSCAN-3910、OPS-3330和APS-3321），检测接受RNE/RNED的209例患者和接受插管的25例患者在临床护理期间的颗粒物产生情况。
RNE和RNED在29.3%和51.0%的受试者中产生的颗粒数量在统计学上显著高于基线水平（P值分别为0.003 - 0.049和0.002 - 0.047）。插管在31.2%的受试者中产生的颗粒数量在统计学上显著高于基线水平（P值为0.001 - 0.015）。所有测试中颗粒的平均直径±标准差为69.9 ± 10.5纳米，99.7%的颗粒直径<300纳米。RNE、RNED和插管之间在颗粒产生方面无统计学差异。咳嗽、打喷嚏或长时间讲话同样在任何操作过程中均未显著影响颗粒产生。
鼻气道操作产生的空气传播气溶胶程度与插管时相似，与咳嗽或打喷嚏等患者反应性行为无关。这些数据表明，有必要更好地理解产生气溶胶操作的定义以及临床环境中操作产生气溶胶的功能后果。
