18 Citations (Scopus)
76 Downloads (Pure)

Abstract

Many guidelines consider supraglottic airway use to be an aerosol-generating procedure. This status requires increased levels of personal protective equipment, fallow time between cases and results in reduced operating theatre efficiency. Aerosol generation has never been quantitated during supraglottic airway use. To address this evidence gap, we conducted real-time aerosol monitoring (0.3–10-µm diameter) in ultraclean operating theatres during supraglottic airway insertion and removal. This showed very low background particle concentrations (median (IQR [range]) 1.6 (0–3.1 [0–4.0]) particles.l−1) against which the patient’s tidal breathing produced a higher concentration of aerosol (4.0 (1.3–11.0 [0–44]) particles.l−1, p = 0.048). The average aerosol concentration detected during supraglottic airway insertion (1.3 (1.0–4.2 [0–6.2]) particles.l−1, n = 11), and removal (2.1 (0–17.5 [0–26.2]) particles.l−1, n = 12) was no different to tidal breathing (p = 0.31 and p = 0.84, respectively). Comparison of supraglottic airway insertion and removal with a volitional cough (104 (66–169 [33–326]), n = 27), demonstrated that supraglottic airway insertion/removal sequences produced <4% of the aerosol compared with a single cough (p < 0.001). A transient aerosol increase was recorded during one complicated supraglottic airway insertion (which initially failed to provide a patent airway). Detailed analysis of this event showed an atypical particle size distribution and we subsequently identified multiple sources of non-respiratory aerosols that may be produced during airway management and can be considered as artefacts. These findings demonstrate supraglottic airway insertion/removal generates no more bio-aerosol than breathing and far less than a cough. This should inform the design of infection prevention strategies for anaesthetists and operating theatre staff caring for patients managed with supraglottic airways.

Original languageEnglish
Pages (from-to)1577–1584
Number of pages8
JournalAnaesthesia
Volume76
Issue number12
Early online date20 Jul 2021
DOIs
Publication statusPublished - 1 Dec 2021

Bibliographical note

Funding Information:
The study was granted Urgent Public Health status by the National Institute for Health Research (NIHR) and is registered in the ISRCTN registry (N21447815). AS is an NIHR‐funded doctoral Research Fellow (NIHR301520), BRB is supported by the Natural Environment Research Council (NE/P018459/1) and FH is a Wellcome GW4‐funded Clinical Doctoral Fellow. The AERATOR study has been fully funded by an NIHR‐UKRI rapid rolling grant. 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. No other external funding or competing interests declared.

Funding Information:
The study was granted Urgent Public Health status by the National Institute for Health Research (NIHR) and is registered in the ISRCTN registry (N21447815). AS is an NIHR-funded doctoral Research Fellow (NIHR301520), BRB is supported by the Natural Environment Research Council (NE/P018459/1) and FH is a Wellcome GW4-funded Clinical Doctoral Fellow. The AERATOR study has been fully funded by an NIHR-UKRI rapid rolling grant. 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. No other external funding or competing interests declared.

Publisher Copyright:
© 2021 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists

Structured keywords

  • AERATOR

Keywords

  • supraglottic airway device
  • SARS-COV-2
  • COVID-19
  • aerosol-generating procedure

Fingerprint

Dive into the research topics of 'A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal'. Together they form a unique fingerprint.

Cite this