Fugitive aerosols in the intensive care unit: a narrative review

O’Toole, Ciarraí; Joyce, Mary; McGrath, James J.; O’Sullivan, Andrew; Byrne, Mary; MacLoughlin, Ronan

doi:10.21037/atm-20-2280

Cited by 16 publications

(16 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study highlights the importance of nebuliser selection as a deciding factor to reduce the risks associated with aerosol therapy during mechanical ventilation. While remaining cognisant of the risks associated with nebuliser selection on the transmission of infection to healthcare workers during drug administration, such as the lack of exhalation limb filtration [26][27][28][29][30], the recommended use of vibrating mesh nebulisers has now been validated.…”

Section: Discussionmentioning

confidence: 99%

Nebuliser Type Influences Both Patient-Derived Bioaerosol Emissions and Ventilation Parameters during Mechanical Ventilation

et al. 2021

Self Cite

View full text Add to dashboard Cite

COVID-19 may lead to serious respiratory complications which may necessitate ventilatory support. There is concern surrounding potential release of patient-derived bioaerosol during nebuliser drug refill, which could impact the health of caregivers. Consequently, mesh nebulisers have been recommended by various clinical practice guidelines. Currently, there is a lack of empirical data describing the potential for release of patient-derived bioaerosol during drug refill. This study examined the release of simulated patient-derived bioaerosol, and the effect on positive end expiratory pressure during nebuliser refill during mechanical ventilation of a simulated patient. During jet nebuliser refill, the positive end expiratory pressure decreased from 4.5 to 0 cm H2O. No loss in pressure was noted during vibrating mesh nebuliser refill. A median particle number concentration of 710 particles cm−3 above ambient was detected when refilling the jet nebuliser in comparison to no increase above ambient detected when using the vibrating mesh nebuliser. The jet nebuliser with the endotracheal tube clamped resulted in 60 particles cm−3 above ambient levels. This study confirms that choice of nebuliser impacts both the potential for patient-derived bioaerosol release and the ability to maintain ventilator circuit pressures and validates the recommended use of mesh nebulisers during mechanical ventilation.

show abstract

Section: Discussionmentioning

confidence: 99%

Nebuliser Type Influences Both Patient-Derived Bioaerosol Emissions and Ventilation Parameters during Mechanical Ventilation

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…A potential associated event concurrent with aerosol therapy and the technologies used to deliver drugs to the lungs is the inadvertent release of a proportion of the drug to the environment. This proportion is released to the environment prior to inhalation by the patient and is referred to as a fugitive emission of medical aerosol [6,8]. Second-hand exposure to medication intended for inhalation by patients may have serious implications for caregivers, other patients, and family members.…”

Section: Introductionmentioning

confidence: 99%

An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

Eain

Joyce

O’Sullivan

et al. 2021

Journal of Hospital Infection

View full text Add to dashboard Cite

Background: During manual resuscitation, nebulizer therapy may be used to deliver therapeutics to patients in respiratory distress. However, the devices used to generate and deliver these medical aerosols have the potential to release these therapeutics into the local environment and expose caregivers to unwanted medical aerosols. Aim: To quantify the levels of fugitive medical aerosol released into the environment during aerosol drug delivery using a manual resuscitation bag with and without filtration. Methods: Time-varying fugitive aerosol concentrations were measured using an aerodynamic particle sizer placed at a position designed to mimic a caregiver. Two nebulizer types were assessed, a vibrating mesh nebulizer and a jet nebulizer. The aerosol dose delivered to the simulated patient lung was also quantified. Findings: Filtration of the exhalation port of the manual resuscitation bag was seen to reduce fugitive medical aerosols to ambient levels for both nebulizer types. The vibrating mesh nebulizer delivered the greatest quantity of aerosol to the simulated adult patient (18.44 AE 1.03% versus 3.64 AE 0.26% with a jet nebulizer). Conclusions: The results highlight the potential for exposure to fugitive medical aerosols released during the delivery of aerosol therapy with a manual resuscitation bag and also the potential for significant variation in patient lung dose depending on nebulizer type.

show abstract

“…• Равномерное распыление и высокая фракция респирабельных частиц (74%) снижают потери лекарства во время распыления [41,42].…”

Section: экономическая эффективность использования небулайзеровunclassified

Place of nebulizer therapy in the treatment of bronchial asthma in children

Potapova

2022

Medicinskij sovet

View full text Add to dashboard Cite

The review article presents an analysis of the data of foreign and domestic researchers characterizing the effectiveness of nebulizer therapy for bronchial asthma in children. The paper considers new data comparing the effectiveness of aerosol delivery devices. The advantage of inhalation therapy, which determines its widespread use in childhood, is its rapid delivery to the respiratory tract, high local and low systemic concentrations of the drug in target organs. Difficulties in observing the correct inhalation technique due to the difficulty of synchronizing inhalation and drug delivery, especially in young children, remain an urgent problem in the practice of treating chronic bronchopulmonary diseases, which leads to a severe and uncontrolled course, disability and adverse outcomes. The main disadvantage of ultrasonic nebulizers is the inactivation of suspensions, antibiotics and other drugs. Widely used jet nebulizers create noise during inhalation, have a large residual volume in the nebulizer chamber. In this regard, the improvement of delivery forms continues, taking into account the anatomical and physiological characteristics of the respiratory organs, the age of patients and comorbid conditions. The characteristics of the optimal inhaler include simplicity and ease of use, reliability, the possibility of effective inhalation of various drugs in combination with economical consumption. From this point of view, one of the universal means of transporting aerosols is membrane or electronic mesh (mesh) nebulizers, which provide excellent regional drug deposition in all age groups of children. The rapid achievement of clinical effect, compactness, mobility expand the possibilities of using mesh nebulizers at all levels of medical care.

show abstract

Fugitive aerosols in the intensive care unit: a narrative review

Cited by 16 publications

References 34 publications

Nebuliser Type Influences Both Patient-Derived Bioaerosol Emissions and Ventilation Parameters during Mechanical Ventilation

Nebuliser Type Influences Both Patient-Derived Bioaerosol Emissions and Ventilation Parameters during Mechanical Ventilation

An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation

Place of nebulizer therapy in the treatment of bronchial asthma in children

Contact Info

Product

Resources

About