A quantitative evaluation of aerosol generation during awake tracheal intubation

Adam R Duffen; The Bristol Awake Fibre-Optic Intubation Collective

doi:10.1111/anae.15968

A quantitative evaluation of aerosol generation during awake tracheal intubation

Adam R Duffen, The Bristol Awake Fibre-Optic Intubation Collective

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Abstract

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-1 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-1 which was significantly greater than volitional coughs (p

Original language	English
Number of pages	11
Journal	Anaesthesia
Volume	78
Issue number	5
Early online date	29 Jan 2023
DOIs	https://doi.org/10.1111/anae.15968
Publication status	E-pub ahead of print - 29 Jan 2023

Bibliographical note

Funding Information:
This study was part of the NIHR‐funded AERATOR study. AS is a National Institute for Health Research (NIHR) funded doctoral Research Fellow and this study is part of the NIHR301520 grant. AERATOR is funded by an NIHR‐UKRI rapid rolling grant (Ref: COV0333). Ethical approval was granted by the Greater Manchester REC and logged in the ISRCTN registry. This report presents independent research commissioned by the NIHR. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, UKRI, or the Department of Health. Bronchoscopes were loaned for the course by Olympus. AP declares advisory board work for Lateral Pharma and consultancy for and research grants from Eli Lilly for projects unrelated to this study. TC declares his department has received airway equipment by donation, at cost or on loan from various manufacturers, none related this study. No other competing interests declared.

Publisher Copyright:
© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

Research Groups and Themes

Anaesthesia Pain and Critical Care

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title = "A quantitative evaluation of aerosol generation during awake tracheal intubation",

abstract = "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-1 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-1 which was significantly greater than volitional coughs (p ",

author = "Shrimpton, {Andrew J} and {O' Farrell}, Genevive and H.M Howes and R Craven and Duffen, {Adam R} and T.M Cook and Reid, {Jonathan P} and J.M Brown and Pickering, {Anthony E} and {The Bristol Awake Fibre-Optic Intubation Collective}",

note = "Funding Information: This study was part of the NIHR‐funded AERATOR study. AS is a National Institute for Health Research (NIHR) funded doctoral Research Fellow and this study is part of the NIHR301520 grant. AERATOR is funded by an NIHR‐UKRI rapid rolling grant (Ref: COV0333). Ethical approval was granted by the Greater Manchester REC and logged in the ISRCTN registry. This report presents independent research commissioned by the NIHR. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, UKRI, or the Department of Health. Bronchoscopes were loaned for the course by Olympus. AP declares advisory board work for Lateral Pharma and consultancy for and research grants from Eli Lilly for projects unrelated to this study. TC declares his department has received airway equipment by donation, at cost or on loan from various manufacturers, none related this study. No other competing interests declared. Publisher Copyright: {\textcopyright} 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.",

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AU - Craven, R

AU - Duffen, Adam R

AU - Cook, T.M

AU - Reid, Jonathan P

AU - Brown, J.M

AU - Pickering, Anthony E

AU - The Bristol Awake Fibre-Optic Intubation Collective

N1 - Funding Information: This study was part of the NIHR‐funded AERATOR study. AS is a National Institute for Health Research (NIHR) funded doctoral Research Fellow and this study is part of the NIHR301520 grant. AERATOR is funded by an NIHR‐UKRI rapid rolling grant (Ref: COV0333). Ethical approval was granted by the Greater Manchester REC and logged in the ISRCTN registry. This report presents independent research commissioned by the NIHR. The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, UKRI, or the Department of Health. Bronchoscopes were loaned for the course by Olympus. AP declares advisory board work for Lateral Pharma and consultancy for and research grants from Eli Lilly for projects unrelated to this study. TC declares his department has received airway equipment by donation, at cost or on loan from various manufacturers, none related this study. No other competing interests declared. Publisher Copyright: © 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.

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N2 - 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-1 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-1 which was significantly greater than volitional coughs (p

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U2 - 10.1111/anae.15968

DO - 10.1111/anae.15968

M3 - Article (Academic Journal)

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SN - 0003-2409

VL - 78

JO - Anaesthesia

JF - Anaesthesia

IS - 5

ER -

A quantitative evaluation of aerosol generation during awake tracheal intubation

Abstract

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