Classification of aerosol-generating procedures: a rapid systematic review.
Tanya D Jackson,Danika Deibert,Graeme Wyatt,Quentin Durand-Moreau,Anil Adisesh,Kamlesh Khunti,Sachin Khunti,Simon Smith,Xin Hui S Chan,Lawrence Ross,Nia Roberts,Elaine Toomey,Trisha Greenhalgh,Isheeta Arora,Susannah M Black,Jonathan Drake,Nandana Syam,Robert J Temple,Sebastian Straube +18 more
TLDR
There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating, however, some clinically relevant procedures received surprisingly little mention in the source documents.Abstract:
In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.read more
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The effect of respiratory activity, non-invasive respiratory support and facemasks on aerosol generation and its relevance to COVID-19.
N. M. Wilson,Guy B. Marks,A. Eckhardt,A. M. Clarke,F. P. Young,Frances L. Garden,W. Stewart,Tim Cook,Tim Cook,Euan R. Tovey +9 more
TL;DR: In this paper, the authors measured the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies and found that respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation.
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Aerosol generating procedures: are they of relevance for transmission of SARS-CoV-2?
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Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes.
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References
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TL;DR: Moher et al. as mentioned in this paper introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses, which is used in this paper.
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Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals.
Yuan Liu,Zhi Ning,Yu Chen,Ming Guo,Yingle Liu,Nirmal Kumar Gali,Li Sun,Yusen Duan,Jing Cai,Dane Westerdahl,Xinjin Liu,Ke Xu,Kin Fai Ho,Haidong Kan,Qingyan Fu,Ke Lan +15 more
TL;DR: It is proposed that room ventilation, open space, sanitization of protective apparel, and proper use and disinfection of toilet areas can effectively limit the concentration of SARS-CoV-2 RNA in aerosols, although the infectivity of the virus RNA was not established in this study.