Seresirikachorn Kachorn, Sirinara Patthrarawalai, Tangjaturonrasme Napadon, Panyametheekul Sirima, Ngamsritrakul Thawat, Supaphan Uraiwan, Boonroung Thirayu, Ongphichetmetha Napassorn, Koosrivinij Saraporn, Snidvongs Kornkiat
Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Otolaryngol Head Neck Surg. 2023 May;168(5):1015-1024. doi: 10.1002/ohn.177. Epub 2023 Jan 19.
To evaluate the role of a negative pressure room with a high-efficiency particulate air (HEPA) filtration system on reducing aerosol exposure in common otolaryngology procedures.
Prospective quantification of aerosol generation.
Tertiary care.
The particle concentrations were measured at various times during tracheostomy tube changes with tracheostomy suctioning, nasal endoscopy with suctioning, and fiberoptic laryngoscopy (FOL), which included 5 times per procedure in a negative pressure isolation room with a HEPA filter and additional 5 times in a nonpressure-controlled room without a HEPA filter. The particle concentrations were measured from the baseline, during the procedure, and continued until 30 minutes after the procedure ended. The particle concentrations were compared to the baseline concentrations.
The particle concentration significantly increased from the baseline during tracheostomy tube changes (mean difference [MD] 0.80 × 10 p/m , p = .01), tracheostomy suctioning (MD 0.78 × 10 p/m , p = .004), at 2 minutes (MD 1.29 × 10 p/m , p = .01), and 3 minutes (MD 1.3 × 10 p/m , p = .004) after suctioning. There were no significant differences in the mean particle concentrations among various time points during nasal endoscopy with suctioning and FOL neither in isolation nor nonpressure-controlled rooms.
A negative pressure isolation room with a HEPA filter was revealed to be safe for medical personnel inside and outside the room. Tracheostomy tube change with tracheostomy suctioning required an isolation room because this procedure generated aerosol, while nasal endoscopy with suctioning and FOL did not. Aerosol generated in an isolation room was diminished to the baseline after 4 minutes.
评估配备高效空气过滤器（HEPA）的负压病房在减少普通耳鼻喉科手术中气溶胶暴露方面的作用。
气溶胶产生的前瞻性定量研究。
三级医疗机构。
在气管切开套管更换并进行气管切开吸引、鼻内镜检查并吸引以及纤维喉镜检查（FOL）过程中的不同时间点测量颗粒浓度，每种操作在配备HEPA过滤器的负压隔离病房中进行5次，在无压力控制且无HEPA过滤器的病房中额外进行5次。从基线开始测量颗粒浓度，在手术过程中持续测量，并持续到手术结束后30分钟。将颗粒浓度与基线浓度进行比较。
在气管切开套管更换期间（平均差值[MD]0.80×10⁶颗粒/立方米，p = 0.01）、气管切开吸引时（MD 0.78×10⁶颗粒/立方米，p = 0.004）、吸引后2分钟（MD 1.29×10⁶颗粒/立方米，p = 0.01）和3分钟（MD 1.3×10⁶颗粒/立方米，p = 0.004），颗粒浓度较基线显著增加。在有吸引的鼻内镜检查和FOL过程中，无论是在隔离病房还是非压力控制病房，各时间点的平均颗粒浓度均无显著差异。
配备HEPA过滤器的负压隔离病房对病房内外的医务人员来说是安全的。气管切开套管更换并进行气管切开吸引需要隔离病房，因为该操作会产生气溶胶，而有吸引的鼻内镜检查和FOL则不会。隔离病房中产生的气溶胶在4分钟后降至基线水平。
