Exhaled Air and Aerosolized Droplet Dispersion During Application of a Jet Nebulizer
Identifieur interne : 000C16 ( Pmc/Checkpoint ); précédent : 000C15; suivant : 000C17Exhaled Air and Aerosolized Droplet Dispersion During Application of a Jet Nebulizer
Auteurs : David S. Hui [Australie] ; Benny K. Chow [Australie] ; Leo C. Y. Chu [Australie] ; Susanna S. Ng [Australie] ; Stephen D. Hall [Australie] ; Tony Gin [Australie] ; Matthew T. V. Chan [Australie]Source :
- Chest [ 0012-3692 ] ; 2009.
Abstract
As part of our influenza pandemic preparedness, we studied the dispersion distances of exhaled air and aerosolized droplets during application of a jet nebulizer to a human patient simulator (HPS) programmed at normal lung condition and different severities of lung injury.
The experiments were conducted in a hospital isolation room with a pressure of − 5 Pa. Airflow was marked with intrapulmonary smoke. The jet nebulizer was driven by air at a constant flow rate of 6 L/min, with the mask reservoir filled with sterile water and attached to the HPS via a nebulizer mask. The exhaled leakage jet plume was revealed by a laser light sheet and images captured by high-definition video. Smoke concentration in the plume was estimated from the light scattered by smoke and droplet particles.
The maximum dispersion distance of smoke particles through the nebulizer side vent was 0.45 m lateral to the HPS at normal lung condition (oxygen consumption, 200 mL/min; lung compliance, 70 mL/cm H2O), but it increased to 0.54 m in mild lung injury (oxygen consumption, 300 mL/min; lung compliance, 35 mL/cm H2O), and beyond 0.8 m in severe lung injury (oxygen consumption, 500 mL/min; lung compliance, 10 mL/cm H2O). More extensive leakage through the side vents of the nebulizer mask was noted with more severe lung injury.
Health-care workers should take extra protective precaution within at least 0.8 m from patients with febrile respiratory illness of unknown etiology receiving treatment via a jet nebulizer even in an isolation room with negative pressure.
Url:
DOI: 10.1378/chest.08-1998
PubMed: 19265085
PubMed Central: 7094435
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Chow</name><affiliation wicri:level="4"><nlm:aff id="aff2">Center for Housing Innovations, Institute of Space and Earth Information Science, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Center for Housing Innovations, Institute of Space and Earth Information Science, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Chu, Leo C Y" sort="Chu, Leo C Y" uniqKey="Chu L" first="Leo C. Y." last="Chu">Leo C. Y. Chu</name><affiliation wicri:level="4"><nlm:aff id="aff3">Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Ng, Susanna S" sort="Ng, Susanna S" uniqKey="Ng S" first="Susanna S." last="Ng">Susanna S. 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Hui</name><affiliation wicri:level="4"><nlm:aff id="aff1">Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Chow, Benny K" sort="Chow, Benny K" uniqKey="Chow B" first="Benny K." last="Chow">Benny K. Chow</name><affiliation wicri:level="4"><nlm:aff id="aff2">Center for Housing Innovations, Institute of Space and Earth Information Science, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Center for Housing Innovations, Institute of Space and Earth Information Science, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Chu, Leo C Y" sort="Chu, Leo C Y" uniqKey="Chu L" first="Leo C. Y." last="Chu">Leo C. Y. Chu</name><affiliation wicri:level="4"><nlm:aff id="aff3">Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Ng, Susanna S" sort="Ng, Susanna S" uniqKey="Ng S" first="Susanna S." last="Ng">Susanna S. Ng</name><affiliation wicri:level="4"><nlm:aff id="aff1">Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Hall, Stephen D" sort="Hall, Stephen D" uniqKey="Hall S" first="Stephen D." last="Hall">Stephen D. Hall</name><affiliation wicri:level="1"><nlm:aff id="aff4">School of Mechanical Engineering, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Mechanical Engineering, The University of New South Wales</wicri:regionArea><wicri:noRegion>The University of New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Gin, Tony" sort="Gin, Tony" uniqKey="Gin T" first="Tony" last="Gin">Tony Gin</name><affiliation wicri:level="4"><nlm:aff id="aff3">Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Chan, Matthew T V" sort="Chan, Matthew T V" uniqKey="Chan M" first="Matthew T. V." last="Chan">Matthew T. V. Chan</name><affiliation wicri:level="4"><nlm:aff id="aff3">Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales</wicri:regionArea><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author></analytic><series><title level="j">Chest</title><idno type="ISSN">0012-3692</idno><idno type="eISSN">1931-3543</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>As part of our influenza pandemic preparedness, we studied the dispersion distances of exhaled air and aerosolized droplets during application of a jet nebulizer to a human patient simulator (HPS) programmed at normal lung condition and different severities of lung injury.</p></sec><sec><title>Methods</title><p>The experiments were conducted in a hospital isolation room with a pressure of − 5 Pa. Airflow was marked with intrapulmonary smoke. The jet nebulizer was driven by air at a constant flow rate of 6 L/min, with the mask reservoir filled with sterile water and attached to the HPS via a nebulizer mask. The exhaled leakage jet plume was revealed by a laser light sheet and images captured by high-definition video. Smoke concentration in the plume was estimated from the light scattered by smoke and droplet particles.</p></sec><sec><title>Findings</title><p>The maximum dispersion distance of smoke particles through the nebulizer side vent was 0.45 m lateral to the HPS at normal lung condition (oxygen consumption, 200 mL/min; lung compliance, 70 mL/cm H<sub>2</sub>O), but it increased to 0.54 m in mild lung injury (oxygen consumption, 300 mL/min; lung compliance, 35 mL/cm H<sub>2</sub>O), and beyond 0.8 m in severe lung injury (oxygen consumption, 500 mL/min; lung compliance, 10 mL/cm H<sub>2</sub>O). More extensive leakage through the side vents of the nebulizer mask was noted with more severe lung injury.</p></sec><sec><title>Interpretation</title><p>Health-care workers should take extra protective precaution within at least 0.8 m from patients with febrile respiratory illness of unknown etiology receiving treatment via a jet nebulizer even in an isolation room with negative pressure.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Abdel Ghafar, An" uniqKey="Abdel Ghafar A">AN Abdel-Ghafar</name></author><author><name sortKey="Chotpitayasunondh, T" uniqKey="Chotpitayasunondh T">T Chotpitayasunondh</name></author><author><name sortKey="Gao, Z" uniqKey="Gao Z">Z Gao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Ds" uniqKey="Hui D">DS Hui</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fabian, P" uniqKey="Fabian P">P 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Chest</journal-id><journal-id journal-id-type="iso-abbrev">Chest</journal-id><journal-title-group><journal-title>Chest</journal-title></journal-title-group><issn pub-type="ppub">0012-3692</issn><issn pub-type="epub">1931-3543</issn><publisher><publisher-name>The American College of Chest Physicians. Published by Elsevier Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19265085</article-id><article-id pub-id-type="pmc">7094435</article-id><article-id pub-id-type="publisher-id">S0012-3692(09)60190-2</article-id><article-id pub-id-type="doi">10.1378/chest.08-1998</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Exhaled Air and Aerosolized Droplet Dispersion During Application of a Jet Nebulizer</article-title></title-group><contrib-group><contrib contrib-type="author" id="au10"><name><surname>Hui</surname><given-names>David S.</given-names></name><degrees>MD, FCCP</degrees><email>dschui@cuhk.edu.hk</email><xref rid="cor1" ref-type="corresp">*</xref><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au20"><name><surname>Chow</surname><given-names>Benny K.</given-names></name><degrees>MPh</degrees><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="au30"><name><surname>Chu</surname><given-names>Leo C.Y.</given-names></name><degrees>MBChB</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au40"><name><surname>Ng</surname><given-names>Susanna S.</given-names></name><degrees>MBChB</degrees><xref rid="aff1" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au50"><name><surname>Hall</surname><given-names>Stephen D.</given-names></name><degrees>PhD</degrees><xref rid="aff4" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="au60"><name><surname>Gin</surname><given-names>Tony</given-names></name><degrees>MD</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="au70"><name><surname>Chan</surname><given-names>Matthew T.V.</given-names></name><degrees>MD</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The University of New South Wales, Australia</aff><aff id="aff2"><label>b</label>Center for Housing Innovations, Institute of Space and Earth Information Science, The Chinese University of Hong Kong, The University of New South Wales, Australia</aff><aff id="aff3"><label>c</label>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, The University of New South Wales, Australia</aff><aff id="aff4"><label>d</label>School of Mechanical Engineering, The University of New South Wales, Australia</aff><author-notes><corresp id="cor1"><label>*</label>Correspondence to: David S. Hui, MD, FCCP, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30–32 Ngan Shing St, Shatin, NT, Hong Kong <email>dschui@cuhk.edu.hk</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>16</day><month>12</month><year>2015</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><month>3</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>16</day><month>12</month><year>2015</year></pub-date><volume>135</volume><issue>3</issue><fpage>648</fpage><lpage>654</lpage><history><date date-type="received"><day>15</day><month>8</month><year>2008</year></date><date date-type="accepted"><day>24</day><month>9</month><year>2008</year></date></history><permissions><copyright-statement>© 2009 The American College of Chest Physicians</copyright-statement><copyright-year>2009</copyright-year><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="ceab10"><sec><title>Background</title><p>As part of our influenza pandemic preparedness, we studied the dispersion distances of exhaled air and aerosolized droplets during application of a jet nebulizer to a human patient simulator (HPS) programmed at normal lung condition and different severities of lung injury.</p></sec><sec><title>Methods</title><p>The experiments were conducted in a hospital isolation room with a pressure of − 5 Pa. Airflow was marked with intrapulmonary smoke. The jet nebulizer was driven by air at a constant flow rate of 6 L/min, with the mask reservoir filled with sterile water and attached to the HPS via a nebulizer mask. The exhaled leakage jet plume was revealed by a laser light sheet and images captured by high-definition video. Smoke concentration in the plume was estimated from the light scattered by smoke and droplet particles.</p></sec><sec><title>Findings</title><p>The maximum dispersion distance of smoke particles through the nebulizer side vent was 0.45 m lateral to the HPS at normal lung condition (oxygen consumption, 200 mL/min; lung compliance, 70 mL/cm H<sub>2</sub>O), but it increased to 0.54 m in mild lung injury (oxygen consumption, 300 mL/min; lung compliance, 35 mL/cm H<sub>2</sub>O), and beyond 0.8 m in severe lung injury (oxygen consumption, 500 mL/min; lung compliance, 10 mL/cm H<sub>2</sub>O). More extensive leakage through the side vents of the nebulizer mask was noted with more severe lung injury.</p></sec><sec><title>Interpretation</title><p>Health-care workers should take extra protective precaution within at least 0.8 m from patients with febrile respiratory illness of unknown etiology receiving treatment via a jet nebulizer even in an isolation room with negative pressure.</p></sec></abstract><kwd-group id="cekeyws30"><title>Key words</title><kwd>dispersion</kwd><kwd>exhaled air</kwd><kwd>influenza</kwd><kwd>jet nebulizer</kwd><kwd>severe acute respiratory syndrome</kwd></kwd-group><kwd-group id="cekeyws20"><title>Abbreviations</title><kwd>HPS, human patient simulator</kwd><kwd>NPPV, noninvasive positive pressure ventilation</kwd><kwd>SARS, severe acute respiratory syndrome</kwd></kwd-group></article-meta></front></pmc><affiliations><list><country><li>Australie</li></country><settlement><li>Sha Tin</li></settlement><orgName><li>Université chinoise de Hong Kong</li></orgName></list><tree><country name="Australie"><noRegion><name sortKey="Hui, David S" sort="Hui, David S" uniqKey="Hui D" first="David S." last="Hui">David S. Hui</name></noRegion><name sortKey="Chan, Matthew T V" sort="Chan, Matthew T V" uniqKey="Chan M" first="Matthew T. V." last="Chan">Matthew T. V. Chan</name><name sortKey="Chow, Benny K" sort="Chow, Benny K" uniqKey="Chow B" first="Benny K." last="Chow">Benny K. Chow</name><name sortKey="Chu, Leo C Y" sort="Chu, Leo C Y" uniqKey="Chu L" first="Leo C. Y." last="Chu">Leo C. Y. Chu</name><name sortKey="Gin, Tony" sort="Gin, Tony" uniqKey="Gin T" first="Tony" last="Gin">Tony Gin</name><name sortKey="Hall, Stephen D" sort="Hall, Stephen D" uniqKey="Hall S" first="Stephen D." last="Hall">Stephen D. Hall</name><name sortKey="Ng, Susanna S" sort="Ng, Susanna S" uniqKey="Ng S" first="Susanna S." last="Ng">Susanna S. Ng</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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