The impact of high-flow nasal cannula (HFNC) on coughing distance: implications on its use during the novel coronavirus disease outbreak
Identifieur interne : 000117 ( Pmc/Corpus ); précédent : 000116; suivant : 000118The impact of high-flow nasal cannula (HFNC) on coughing distance: implications on its use during the novel coronavirus disease outbreak
Auteurs : Ne-Hooi Will Loh ; Yanni Tan ; Juvel Taculod ; Billy Gorospe ; Analine S. Teope ; Jyoti Somani ; Addy Yong Hui TanSource :
- Canadian Journal of Anaesthesia [ 0832-610X ] ; 2020.
Url:
DOI: 10.1007/s12630-020-01634-3
PubMed: 32189218
PubMed Central: 7090637
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Teope</name><affiliation><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</nlm:aff></affiliation></author><author><name sortKey="Somani, Jyoti" sort="Somani, Jyoti" uniqKey="Somani J" first="Jyoti" last="Somani">Jyoti Somani</name><affiliation><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>Department of Medicine, Division of Infectious Diseases,</institution><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</nlm:aff></affiliation></author><author><name sortKey="Tan, Addy Yong Hui" sort="Tan, Addy Yong Hui" uniqKey="Tan A" first="Addy Yong Hui" last="Tan">Addy Yong Hui Tan</name><affiliation><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>Department of Anaesthesia,</institution><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</nlm:aff></affiliation></author></analytic><series><title level="j">Canadian Journal of Anaesthesia</title><idno type="ISSN">0832-610X</idno><idno type="eISSN">1496-8975</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zhou, F" uniqKey="Zhou F">F Zhou</name></author><author><name sortKey="Yu, T" uniqKey="Yu T">T Yu</name></author><author><name sortKey="Du, R" uniqKey="Du R">R Du</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Ds" uniqKey="Hui D">DS Hui</name></author><author><name sortKey="Chow, Bk" uniqKey="Chow B">BK Chow</name></author><author><name sortKey="Lo, T" uniqKey="Lo T">T Lo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Leung, Cc" uniqKey="Leung C">CC Leung</name></author><author><name sortKey="Joynt, Gm" uniqKey="Joynt G">GM Joynt</name></author><author><name sortKey="Gomersall, Cd" uniqKey="Gomersall C">CD Gomersall</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wax, Rs" uniqKey="Wax R">RS Wax</name></author><author><name sortKey="Christian, Md" uniqKey="Christian M">MD Christian</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Can J Anaesth</journal-id><journal-id journal-id-type="iso-abbrev">Can J Anaesth</journal-id><journal-title-group><journal-title>Canadian Journal of Anaesthesia</journal-title></journal-title-group><issn pub-type="ppub">0832-610X</issn><issn pub-type="epub">1496-8975</issn><publisher><publisher-name>Springer International Publishing</publisher-name><publisher-loc>Cham</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32189218</article-id><article-id pub-id-type="pmc">7090637</article-id><article-id pub-id-type="publisher-id">1634</article-id><article-id pub-id-type="doi">10.1007/s12630-020-01634-3</article-id><article-categories><subj-group subj-group-type="heading"><subject>Correspondence</subject></subj-group></article-categories><title-group><article-title>The impact of high-flow nasal cannula (HFNC) on coughing distance: implications on its use during the novel coronavirus disease outbreak</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Loh</surname><given-names>Ne-Hooi Will</given-names></name><degrees>MBBS</degrees><address><email>will.loh@nus.edu.sg</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tan</surname><given-names>Yanni</given-names></name><degrees>MBBS</degrees><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Taculod</surname><given-names>Juvel</given-names></name><degrees>BSRT</degrees><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Gorospe</surname><given-names>Billy</given-names></name><degrees>BSRT</degrees><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Teope</surname><given-names>Analine S.</given-names></name><degrees>BSN</degrees><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Somani</surname><given-names>Jyoti</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Tan</surname><given-names>Addy Yong Hui</given-names></name><degrees>MBBS</degrees><xref ref-type="aff" rid="Aff1">1</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>Department of Anaesthesia,</institution><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>Division of Critical Care – Respiratory Therapy,</institution><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="GRID">grid.412106.0</institution-id><institution-id institution-id-type="ISNI">0000 0004 0621 9599</institution-id><institution>Department of Medicine, Division of Infectious Diseases,</institution><institution>National University Hospital,</institution></institution-wrap>Singapore, Singapore</aff></contrib-group><pub-date pub-type="epub"><day>18</day><month>3</month><year>2020</year></pub-date><fpage>1</fpage><lpage>2</lpage><history><date date-type="received"><day>15</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>15</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© Canadian Anesthesiologists' Society 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions></article-meta></front><body><p id="Par1"><bold>To the Editor,</bold></p><p id="Par2">Novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 threatens healthcare resources throughout the world. This is particularly true for the patients who develop moderate to severe respiratory failure and require oxygen supplementation devices such as high-flow nasal cannula (HFNC).<xref ref-type="bibr" rid="CR1">1</xref> The HFNC uses humidification to allow the delivery of up to 100% oxygen at flow rates of up to 60 L·min<sup>−1</sup>; however, there is a concern this may aerosolize respiratory tract pathogens.</p><p id="Par3">The World Health Organization (WHO) released interim guidance on the management of severe respiratory infection when COVID-19 is suspected.<xref ref-type="bibr" rid="CR2">2</xref> Using evidence from several recently published studies,<xref ref-type="bibr" rid="CR2">2</xref>,<xref ref-type="bibr" rid="CR3">3</xref> WHO guidance proffers that HFNC do not create wide-spread dispersion of exhaled air and therefore should be associated with low risk of transmission of respiratory viruses. This document also recommends wearing a standard medical face mask if the healthcare worker is within 2 m of the patient and there is a physical bed separation of at least 1 m.</p><p id="Par4">We carried out an experiment to simulate a patient coughing while using HFNC to assess the maximum distance of droplet dispersion. Formal ethics approval was waived by the Office of Human Research Protection Programme, National Healthcare Group, Singapore. The authors (<italic>n</italic> = 5), with no history of lung disease, participated. All gargled 10 mL of diluted red then blue food dye. They were then seated with their mouths approximately 1.30 m from the floor, inhaled to vital capacity, and coughed with an open mouth. Each participant coughed twice and the furthest distance that a visible food dye droplet travelled on the ground was measured. The process was repeated while wearing a well-fitting HFNC (2004F7015 High/Low Blender, Bio-Med USA and Optiflo, Fisher Paykel Healthcare New Zealand) at 60 L·min<sup>−1</sup> flow.</p><p id="Par5">We showed that in these healthy volunteers, cough-generated droplets spread to a mean (standard deviation) distance of 2.48 (1.03) m at baseline and 2.91 (1.09) m with HFNC. A maximum cough distance of 4.50 m was reported when using HFNC (Table).<table-wrap id="Tab1"><label>Table</label><caption><p>Droplet dispersion distances during simulated coughing</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left">Participant</th><th align="left">Distance without HFNC (m)</th><th align="left">Distance with HFNC (m)</th><th align="left">Difference in distance (m)</th></tr></thead><tbody><tr><td align="left">Female, 159 cm, 46 kg</td><td align="left">1.03</td><td align="left">1.53</td><td align="left">0.50</td></tr><tr><td align="left">Male, 171 cm, 76 kg</td><td align="left">2.33</td><td align="left">3.17</td><td align="left">0.84</td></tr><tr><td align="left">Male, 171 cm, 79 kg</td><td align="left">3.90</td><td align="left">4.50</td><td align="left">0.60</td></tr><tr><td align="left">Male, 170 cm, 70 kg</td><td align="left">2.43</td><td align="left">2.41</td><td align="left">− 0.02</td></tr><tr><td align="left">Female, 161 cm, 71 kg</td><td align="left">2.73</td><td align="left">2.92</td><td align="left">0.19</td></tr><tr><td align="left">Mean (SD) values</td><td align="left">2.48 (1.03)</td><td align="left">2.91 (1.09)</td><td align="left">0.42 (0.34)</td></tr></tbody></table><table-wrap-foot><p>HFNC = high-flow nasal cannula; SD = standard deviation</p></table-wrap-foot></table-wrap></p><p id="Par6">Hui <italic>et al.</italic><xref ref-type="bibr" rid="CR3">3</xref> used a simulator model and a smoke-laser illumination technique to investigate the dispersion of droplets amplified by HFNC. They showed that when HFNC flow rates were increased from 10–60 L·min<sup>−1</sup>, non-cough exhaled air distances (in the forward direction) increased from 6.5 to 17.2 cm, and up to 62 cm (in the lateral direction). It is uncertain if such short distances are accurate in patients who are coughing. Leung <italic>et al</italic>.<xref ref-type="bibr" rid="CR4">4</xref> found no evidence of increased surrounding surface contamination when using HFNC in patients with gram negative bacterial pneumonia. Nevertheless, extrapolating findings from patients with bacterial pneumonia to those with viral pneumonia may not be rational. In our study, four of the five volunteers’ cough droplets travelled further than the WHO-recommended 2 m safe exclusion zone. Overall, the distance of droplet dispersion from coughing increased by an average of 0.42 m with HFNC. Using the other studies<xref ref-type="bibr" rid="CR3">3</xref>,<xref ref-type="bibr" rid="CR4">4</xref> as a guide, the safest way to use HFNC during the current COVID-19 outbreak is to embrace the potential of nosocomial airborne transmission and ensure HFNC devices are at least used in single occupancy rooms or negative pressure airborne isolation rooms<xref ref-type="bibr" rid="CR5">5</xref> when possible. Healthcare workers caring for those using HFNC should be wearing full airborne personal protective equipment (i.e., N95 mask or equivalent, gown, gloves, goggles, hair covers, and face shield or hoods).</p></body><back><fn-group><fn><p><bold>Publisher's Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><ack><title>Acknowledgement</title><p>Dr. Matt Cove for his help in the drafting of this manuscript.</p><sec id="FPar1"><title>Conflicts of interest</title><p id="Par7">None.</p></sec><sec id="FPar2"><title>Funding statement</title><p id="Par8">None.</p></sec><sec id="FPar3"><title>Editorial responsibility</title><p id="Par9">This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, <italic>Canadian Journal of Anesthesia</italic>.</p></sec></ack><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhou</surname><given-names>F</given-names></name><name><surname>Yu</surname><given-names>T</given-names></name><name><surname>Du</surname><given-names>R</given-names></name><etal></etal></person-group><article-title>Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China : a retrospective cohort study</article-title><source>Lancet</source><year>2020</year><pub-id pub-id-type="doi">10.1016/S0140-6736(20)30566-3</pub-id><pub-id pub-id-type="pmid">32178766</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><mixed-citation publication-type="other"><italic>World Health Organization.</italic> Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected. 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Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected">https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hui</surname><given-names>DS</given-names></name><name><surname>Chow</surname><given-names>BK</given-names></name><name><surname>Lo</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks</article-title><source>Eur Respir J</source><year>2019</year><pub-id pub-id-type="doi">10.1183/13993003.02339-2018</pub-id><pub-id pub-id-type="pmid">30705129</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Leung</surname><given-names>CC</given-names></name><name><surname>Joynt</surname><given-names>GM</given-names></name><name><surname>Gomersall</surname><given-names>CD</given-names></name><etal></etal></person-group><article-title>Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: a randomized controlled crossover trial</article-title><source>J Hosp Infect</source><year>2019</year><volume>101</volume><fpage>84</fpage><lpage>87</lpage><pub-id pub-id-type="doi">10.1016/j.jhin.2018.10.007</pub-id><pub-id pub-id-type="pmid">30336170</pub-id></element-citation></ref><ref id="CR5"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wax</surname><given-names>RS</given-names></name><name><surname>Christian</surname><given-names>MD</given-names></name></person-group><article-title>Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients</article-title><source>Can J Anesth</source><year>2020</year><pub-id pub-id-type="doi">10.1007/s12630-020-01591-x</pub-id><pub-id pub-id-type="pmid">32052373</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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