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Aerosol Generation During Laryngology Procedures in the Operating Room #MMPMID34213770
Zheng M; Lui C; O'Dell K; M Johns M; Ference EH; Hur K
Laryngoscope 2021[Dec]; 131 (12): 2759-2765 PMID34213770show ga
OBJECTIVE: Severe acute respiratory syndrome coronavirus-2 spreads through respiratory fluids. We aim to quantify aerosolized particles during laryngology procedures to understand their potential for transmission of infectious aerosol-based diseases. STUDY DESIGN: Prospective quantification of aerosol generation. METHODS: Airborne particles (0.3-25 mum in diameter) were measured during live-patient laryngology surgeries using an optical particle counter positioned 60 cm from the oral cavity to the surgeon's left. Measurements taken during the procedures were compared to baseline concentrations recorded immediately before each procedure. Procedures included direct laryngoscopy with general endotracheal anesthesia (GETA), direct laryngoscopy with jet ventilation, and carbon dioxide (CO(2) ) laser use with or without jet ventilation, all utilizing intermittent suction. RESULTS: Greater than 99% of measured particles were 0.3 to 1.0 mum in diameter. Compared to baseline, direct laryngoscopy was associated with a significant 6.71% increase in cumulative particles, primarily 0.3 to 1.0 mum particles (P < .0001). 1.0 to 25 mum particles significantly decreased (P < .001). Jet ventilation was not associated with a significant change in cumulative particles; when analyzing differential particle sizes, only 10 to 25 mum particles exhibited a significant increase compared to baseline (+42.40%, P = .002). Significant increases in cumulative particles were recorded during CO(2) laser use (+14.70%, P < .0001), specifically in 0.3 to 2.5 mum particles. Overall, there was no difference when comparing CO(2) laser use during jet ventilation versus GETA. CONCLUSIONS: CO(2) laser use during laryngology surgery is associated with significant increases in airborne particles. Although direct laryngoscopy with GETA is associated with slight increases in particles, jet ventilation overall does not increase particle aerosolization. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2759-2765, 2021.
Laryngoscope 2021 ; 131 (12): 2759-2765
