Assessment of dispersion of airborne particles of oral/nasal fluid by high flow nasal cannula therapy

Autor: Robert Stuart Kirton, Jane O'Donnell, Mark Jermy, Yannan Jiang, H. Hockey, Ronald L. Dougherty, Callum James Thomas Spence, A.S. Mahaliyana, Natalia Kabaliuk, P. Rowe, Sally Roberts, A. Gibbs, Sally Gaw, Z. Zulkhairi Abidin
Jazyk: angličtina
Rok vydání: 2021
Předmět:
B Vitamins
Male
Pulmonology
Physiology
Epidemiology
Riboflavin
medicine.disease_cause
Sneezing
0302 clinical medicine
Medical Conditions
Coughing
Medicine and Health Sciences
030212 general & internal medicine
Materials
Multidisciplinary
Microscopy
Video
Organic Compounds
Respiration
digestive
oral
and skin physiology
Respiratory infection
Vitamins
Chemistry
Infectious Diseases
Breath Tests
Breathing
Exhalation
Anesthesia
Physical Sciences
Medicine
Female
medicine.symptom
Nasal cannula
Research Article
Adult
Sneeze
Respiratory rate
Science
Materials Science
Surgical and Invasive Medical Procedures
Nose
03 medical and health sciences
Respiratory Disorders
Signs and Symptoms
Respiratory Rate
medicine
Cannula
Humans
Nasal fluid
Aerosols
business.industry
Organic Chemistry
Chemical Compounds
Oxygen Inhalation Therapy
Biology and Life Sciences
COVID-19
030228 respiratory system
Medical Risk Factors
Mixtures
Respiratory Infections
Clinical Medicine
business
Physiological Processes
Intubation
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 2, p e0246123 (2021)
ISSN: 1932-6203
Popis: Background Nasal High Flow (NHF) therapy delivers flows of heated humidified gases up to 60 LPM (litres per minute) via a nasal cannula. Particles of oral/nasal fluid released by patients undergoing NHF therapy may pose a cross-infection risk, which is a potential concern for treating COVID-19 patients. Methods Liquid particles within the exhaled breath of healthy participants were measured with two protocols: (1) high speed camera imaging and counting exhaled particles under high magnification (6 participants) and (2) measuring the deposition of a chemical marker (riboflavin-5-monophosphate) at a distance of 100 and 500 mm on filter papers through which air was drawn (10 participants). The filter papers were assayed with HPLC. Breathing conditions tested included quiet (resting) breathing and vigorous breathing (which here means nasal snorting, voluntary coughing and voluntary sneezing). Unsupported (natural) breathing and NHF at 30 and 60 LPM were compared. Results Imaging: During quiet breathing, no particles were recorded with unsupported breathing or 30 LPM NHF (detection limit for single particles 33 μm). Particles were detected from 2 of 6 participants at 60 LPM quiet breathing at approximately 10% of the rate caused by unsupported vigorous breathing. Unsupported vigorous breathing released the greatest numbers of particles. Vigorous breathing with NHF at 60 LPM, released half the number of particles compared to vigorous breathing without NHF. Chemical marker tests: No oral/nasal fluid was detected in quiet breathing without NHF (detection limit 0.28 μL/m3). In quiet breathing with NHF at 60 LPM, small quantities were detected in 4 out of 29 quiet breathing tests, not exceeding 17 μL/m3. Vigorous breathing released 200–1000 times more fluid than the quiet breathing with NHF. The quantities detected in vigorous breathing were similar whether using NHF or not. Conclusion During quiet breathing, 60 LPM NHF therapy may cause oral/nasal fluid to be released as particles, at levels of tens of μL per cubic metre of air. Vigorous breathing (snort, cough or sneeze) releases 200 to 1000 times more oral/nasal fluid than quiet breathing (p < 0.001 with both imaging and chemical marker methods). During vigorous breathing, 60 LPM NHF therapy caused no statistically significant difference in the quantity of oral/nasal fluid released compared to unsupported breathing. NHF use does not increase the risk of dispersing infectious aerosols above the risk of unsupported vigorous breathing. Standard infection prevention and control measures should apply when dealing with a patient who has an acute respiratory infection, independent of which, if any, respiratory support is being used. Clinical trial registration ACTRN12614000924651
Databáze: OpenAIRE
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