Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

Kumar, Sathish; Kapoor, Lalit; Barman, Dhiraj; Narayan, Pradeep

doi:10.1111/jocs.14728

Cited by 5 publications

(7 citation statements)

References 13 publications

(14 reference statements)

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“…However, the device manufacturers do not have data on filtration efficiency for smaller particle sizes than 0.1 μm. While influenza is much larger than 0.1 μm, COVID‐19 size is cited to be 0.06 to 0.14 μm in diameter 33,34 . Furthermore, every breath‐hold technique suffers from significantly deteriorated duty‐cycle, causing noticeable increase of contact and care time.…”

Section: Discussionmentioning

confidence: 99%

“…While influenza is much larger than 0.1 µm, COVID-19 size is cited to be 0.06 to 0.14 µm in diameter. 33,34 Furthermore, every breath-hold technique suffers from significantly deteriorated duty-cycle, causing noticeable increase of contact and care time. Therefore, in the face of such uncertainty, our clinic has sought alternative methods.…”

Section: Max Deviation From Eoi (Mm)mentioning

confidence: 99%

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Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management

Sohn,

Polizzi,

McDonagh

et al. 2023

J Applied Clin Med Phys

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ObjectivesAs an alternative to conventional compression amidst the COVID‐19 pandemic, we developed a contactless motion management strategy. By increasing the patient's breathing rate to induce shallow breathing with the aid of a metronome, our hypothesis is that the motion magnitude of the target may be minimized without physical contact or compression.MethodsFourteen lung stereotactic body radiation therapy (SBRT) patients treated under fast shallow‐breathing (FSB) were selected for inclusion in this retrospective study. Our proposed method is called shallow kinetics induced by a metronome (SKIM). We induce FSB by setting the beats‐per‐minute (BPM) high (typically in the range of 50–60). This corresponded to a patient breathing rate of 25–30 (breathing) cycles per minute. The magnitude of target motion in 3D under SKIM was evaluated using 4DCT datasets. Comparison with free breathing (FB) 4DCT was also made for a subset for which FB data available.ResultsThe overall effectiveness of SKIM was evaluated with 18 targets (14 patients). Direct comparison with FB was performed with 12 targets (10 patients). The vector norm mean ± SD value of motion magnitude under SKIM for 18 targets was 8.2 ± 4.1 mm. The mean ± SD metronome BPM was 54.9 ± 4.0 in this group. The vector norm means ± SD values of target motion for FB and SKIM in the 12 target sub‐group were 14.6 ± 8.5 mm and 9.3 ± 3.7 mm, respectively. The mean ± SD metronome BPM for this sub‐group was 56.3 ± 2.5.ConclusionCompared with FB, SKIM can significantly reduce respiratory motion magnitude of thoracic targets. The difference in maximum motion reduction in the overall vector norm, S‐I, and A‐P directions was significant (p = 0.033, 0.042, 0.011). Our proposed method can be an excellent practical alternative to conventional compression due to its flexibility and ease of implementation.

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Section: Discussionmentioning

confidence: 99%

Section: Max Deviation From Eoi (Mm)mentioning

confidence: 99%

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management

Sohn,

Polizzi,

McDonagh

et al. 2023

J Applied Clin Med Phys

View full text Add to dashboard Cite

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“…44 When establishing surgical access to the chest, ventilation should be interrupted before incision; single-lung ventilation should be resumed when lung integrity and adequate lung exclusion are confirmed. 45 Transoesophageal echocardiography is regarded as a potential AGP 46 and should only be performed when necessary. 47 Similar caution is needed for other potential AGPs such as sternotomy, thoracotomy, chest drain insertion, and the use of a blower-mister during off-pump coronary artery bypass surgery.…”

Section: Cardiothoracic Surgerymentioning

confidence: 99%

Mitigation of COVID-19 transmission in endoscopic and surgical aerosol-generating procedures: a narrative review of early-pandemic literature

Chan

Rahman

et al. 2023

Hong Kong Med J

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A comprehensive literature search was performed using a combination of keywords (MeSH terms and free text words) including 'COVID-19'/ 'SARS-CoV*'/'SARS'/'MERS' , 'aerosol' , 'surgery' , 'operation/procedure' , 'endoscopy' , and 'healthcare workers' . MEDLINE, Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to 18 July 2020. Preprint servers, medRxiv, and bioRxiv were also searched for information up to that date. The search was limited to studies published during or after 2003, when the SARS outbreak began. Only articles published in English or published in another language but containing an English abstract were included. The search strategy is presented in the online supplementary Appendix. The search results were supplemented by guidelines from professional bodies. Results Perioperative considerations Preoperative considerationsFor all specialties, only urgent and essential procedures should be performed during the pandemic, 6 with

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“…14 15 Since tracheal intubation is an aerosolgenerating procedure and COVID-19 has the ability to remain viable and infectious on certain surfaces during a surgical procedure, there may be an increased risk of viral transmission during surgical procedures. [16][17][18] Consequently, these infected asymptomatic patients may be able to spread the virus to healthcare personnel and or other hospitalised patients. [19][20][21][22][23] Nevertheless, mandatory COVID-19 screening before all surgical procedures requires testing equipment and is time-consuming, leading to additional pressure on hospital staff and overall healthcare and increased costs.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

et al. 2022

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ObjectivesPatients with COVID-19 may be asymptomatic and are able to transmit COVID-19 during a surgical procedure, resulting in increased pressure on healthcare and reduced control of COVID-19 spread. There remains uncertainty about the implementation of preoperative screening for COVID-19 in asymptomatic surgical patients. Therefore, this study aims to determine the prevalence of preoperative COVID-19, confirmed by reverse transcriptase PCR (RT-PCR), in asymptomatic patients.DesignSystematic review and meta-analysis.Data sourcesPubmed and Embase databases were searched through 20 February 2022.Eligibility criteriaAll COVID-19 articles including preoperative asymptomatic patients were included.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Meta-analysis was performed to determine the prevalence of COVID-19 with 95% CI. Moreover, estimated positive predictive value (PPV), negative predictive value, false-positives (FP) and false-negatives were calculated for preoperative asymptomatic patients.ResultsTwenty-seven studies containing 27 256 asymptomatic preoperative screened patients were included, of which 431 were positive for COVID-19 by RT-PCR test. In addition, the meta-analysis revealed a pooled COVID-19 prevalence of 0.76% (95% CI 0.36% to 1.59%). The calculated PPV for this prevalence is 40.8%.ConclusionsThe pooled COVID-19 prevalence in asymptomatic patients tested preoperatively was 0.76%, with low corresponding PPV. Consequently, nearly three-quarters of postponed surgical procedures in asymptomatic preoperative patients may be FP. In the event of similar pandemics, modification of preoperative mandatory RT-PCR COVID-19 testing in asymptomatic patients may be considered.

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Aerosol‐mediated transmission of SARS‐Cov‐2 or COVID‐19 in the cardiac surgical operating room

Cited by 5 publications

References 13 publications

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management

Shallow kinetics induced by a metronome (SKIM): A novel contactless respiratory motion management

Mitigation of COVID-19 transmission in endoscopic and surgical aerosol-generating procedures: a narrative review of early-pandemic literature

Meta-analysis of COVID-19 prevalence during preoperative COVID-19 screening in asymptomatic patients

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