Research and Development, Science and Emerging Technologies, Aerogen Ltd, IDA Business Park, Dangan, Galway, H91HE94, Ireland.
School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland.
J Clin Monit Comput. 2023 Oct;37(5):1265-1273. doi: 10.1007/s10877-023-00990-x. Epub 2023 Mar 17.
Awake Tracheal Intubation (ATI) can be performed in cases where there is potential for difficult airway management. It is considered an aerosol generating procedure and is a source of concern to healthcare workers due to the risk of transmission of airborne viral infections, such as SARS-CoV-2. At present, there is a lack of data on the quantities, size distributions and spread of aerosol particles generated during such procedures. This was a volunteer observational study which took place in an operating room of a university teaching hospital. Optical particle sizers were used to provide real time aerosol characterisation during a simulated ATI performed with concurrent high-flow nasal oxygen therapy. The particle sizers were positioned at locations that represented the different locations of clinical staff in an operating room during an ATI. The greatest concentration of patient derived aerosol particles was within 0.5-1.0 m of the subject and along their midline, 2242 #/cm. As the distance, both radial and longitudinal, from the subject increased, the concentration decreased towards ambient levels, 36.9 ± 5.1 #/cm. Patient derived aerosol particles < 5 µm in diameter remained entrained in the exhaled aerosol plume and fell to the floor or onto the subject. Patient derived particles > 5 µm in diameter broke away from the exhaled plume and spread radially throughout the operating room. Irrespective of distance and ventilation status, full airborne protective equipment should be worn by all staff when ATI is being performed on patients with suspected viral respiratory infections.
清醒气管插管（ATI）可在存在困难气道管理的情况下进行。它被认为是一种气溶胶产生程序，由于 SARS-CoV-2 等空气传播病毒感染的传播风险，引起医护人员的关注。目前，关于在这种程序中产生的气溶胶颗粒的数量、大小分布和传播的数据很少。这是一项在大学教学医院手术室进行的志愿者观察性研究。在使用高流量鼻氧疗法同时进行模拟 ATI 时，使用光学粒子计数器实时提供气溶胶特征。粒子计数器放置在手术室中进行 ATI 时代表临床工作人员不同位置的位置。最大浓度的患者来源气溶胶颗粒位于距受试者 0.5-1.0 m 以内，沿其中线为 2242 #/cm。随着距受试者的距离，无论是径向还是纵向，浓度都会降低到环境水平，为 36.9 ± 5.1 #/cm。直径小于 5 µm 的患者来源气溶胶颗粒仍被包含在呼出的气溶胶羽流中，并降落到地板上或受试者身上。直径大于 5 µm 的患者来源颗粒会从呼出的羽流中分离出来，并在整个手术室中径向扩散。无论距离和通风状况如何，在对疑似病毒呼吸道感染的患者进行 ATI 时，所有工作人员都应穿戴完整的空气传播防护设备。
