Abstract
Background
Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence.
Aim
To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients.
Methods
This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3–10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation.
Findings
Aerosol was reliably detected {median 65 [interquartile range (IQR) 39–259] particles/L} above background [median 4.8 (IQR 1–7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0–12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30–75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600–4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300–1826) particles/L, P<0.0001].
Conclusion
Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence.
Aim
To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients.
Methods
This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3–10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation.
Findings
Aerosol was reliably detected {median 65 [interquartile range (IQR) 39–259] particles/L} above background [median 4.8 (IQR 1–7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0–12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30–75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600–4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300–1826) particles/L, P<0.0001].
Conclusion
Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
Original language | English |
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Pages (from-to) | 13-21 |
Number of pages | 9 |
Journal | Journal of Hospital Infection |
Volume | 124 |
Early online date | 8 Mar 2022 |
DOIs | |
Publication status | Published - 1 Jun 2022 |
Bibliographical note
Funding Information:AEP declares advisory board work for Lateral Pharma, and consultancy for and research grants from Eli Lilly for projects unrelated to this study.
Funding Information:
The AERATOR study is registered in the ISRCTN registry (ISRCT N21447815). Andrew Shrimpton is an NIHR-funded Doctoral Research Fellow, and the MAGPIE study is part of the NIHR301520 grant. AERATOR is funded by an NIHR-UKRI rapid rolling grant (Ref. COV0333 ). This article presents independent research commissioned by NIHR . The views and opinions expressed by the authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service, NIHR, UK Research and Innovation, or the Department of Health.
Funding Information:
The AERATOR study is registered in the ISRCTN registry (ISRCT N21447815). Andrew Shrimpton is an NIHR-funded Doctoral Research Fellow, and the MAGPIE study is part of the NIHR301520 grant. AERATOR is funded by an NIHR-UKRI rapid rolling grant (Ref. COV0333). This article presents independent research commissioned by NIHR. The views and opinions expressed by the authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service, NIHR, UK Research and Innovation, or the Department of Health.
Publisher Copyright:
© 2022 The Author(s)
Research Groups and Themes
- Anaesthesia Pain and Critical Care
Keywords
- Aerosol
- Suction
- Upper airway
- Open suctioning