A quantitative evaluation of aerosol generation during awake tracheal intubation

Aerosol-generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which ma...

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Bibliographic Details
Published in:Anaesthesia 2023-05, Vol.78 (5), p.587-597
Main Authors: Shrimpton, A J, O'Farrell, G, Howes, H M, Craven, R, Duffen, A R, Cook, T M, Reid, J P, Brown, J M, Pickering, A E
Format: Article
Language:English
Subjects:
Aerosols
Airborne infection
Bronchoscopy
Cough
Cough - etiology
Endoscopy
Humans
Instrumentation
Intubation
Intubation, Intratracheal - methods
Larynx
Lidocaine
Medical instruments
Pathogens
Respiratory Aerosols and Droplets
Respiratory tract
Risk assessment
Vocal cords
Vocal organs
Wakefulness
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Summary:Aerosol-generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which may generate aerosol. To assess the risk, we undertook aerosol monitoring during a series of awake tracheal intubations and nasendoscopies in healthy participants. Sampling was undertaken within an ultraclean operating theatre. Procedures were performed and received by 12 anaesthetic trainees. The upper airway was topically anaesthetised with lidocaine and participants were not sedated. An optical particle sizer continuously sampled aerosol. Passage of the bronchoscope through the vocal cords generated similar peak median (IQR [range]) aerosol concentrations to coughing, 1020 (645-1245 [120-48,948]) vs. 1460 (390-2506 [40-12,280]) particles.l respectively, p = 0.266. Coughs evoked when lidocaine was sprayed on the vocal cords generated 91,700 (41,907-166,774 [390-557,817]) particles.l which was significantly greater than volitional coughs (p 
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.15968