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Wilson NM, Calabria C, Warren A, Finlay A, O'Donovan A, Passerello GL, Ribaric NL, Ward P, Gillespie R, Farrel R, McNarry AF, Pan D. Quantifying hospital environmental ventilation using carbon dioxide monitoring - a multicentre study. Anaesthesia 2024; 79:147-155. [PMID: 38059394 DOI: 10.1111/anae.16124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol-generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high-risk infective or immunocompromised patients may be isolated to reduce cross-infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two-phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non-dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient-occupied (clinical) and staff break and office (non-clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID-19 are cared for routinely, as well as ICUs and operating theatres where aerosol-generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non-clinical areas vs. 7% in clinical areas (p < 0.001). In non-clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation.
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Affiliation(s)
- N M Wilson
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - C Calabria
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Warren
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A Finlay
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A O'Donovan
- Department of Process, Energy and Transport Engineering, MeSSO Research Group, Munster Technological University, Cork, Ireland
| | - G L Passerello
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - N L Ribaric
- Faculty of Medicine, University Medical Centre Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - P Ward
- Department of Anaesthesia, St John's Hospital, Livingston, UK
| | - R Gillespie
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - R Farrel
- Department of Anaesthesia and Critical Care, Victoria Hospital, Kirkcaldy, UK
| | - A F McNarry
- Department of Anaesthesia, Western General Hospital, UK
| | - D Pan
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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2
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Shrimpton AJ, Brown V, Vassallo J, Nolan JP, Soar J, Hamilton F, Cook TM, Bzdek BR, Reid JP, Makepeace CH, Deutsch J, Ascione R, Brown JM, Benger JR, Pickering AE. A quantitative evaluation of aerosol generation during cardiopulmonary resuscitation. Anaesthesia 2024; 79:156-167. [PMID: 37921438 PMCID: PMC10952244 DOI: 10.1111/anae.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/04/2023]
Abstract
It is unclear if cardiopulmonary resuscitation is an aerosol-generating procedure and whether this poses a risk of airborne disease transmission to healthcare workers and bystanders. Use of airborne transmission precautions during cardiopulmonary resuscitation may confer rescuer protection but risks patient harm due to delays in commencing treatment. To quantify the risk of respiratory aerosol generation during cardiopulmonary resuscitation in humans, we conducted an aerosol monitoring study during out-of-hospital cardiac arrests. Exhaled aerosol was recorded using an optical particle sizer spectrometer connected to the breathing system. Aerosol produced during resuscitation was compared with that produced by control participants under general anaesthesia ventilated with an equivalent respiratory pattern to cardiopulmonary resuscitation. A porcine cardiac arrest model was used to determine the independent contributions of ventilatory breaths, chest compressions and external cardiac defibrillation to aerosol generation. Time-series analysis of participants with cardiac arrest (n = 18) demonstrated a repeating waveform of respiratory aerosol that mapped to specific components of resuscitation. Very high peak aerosol concentrations were generated during ventilation of participants with cardiac arrest with median (IQR [range]) 17,926 (5546-59,209 [1523-242,648]) particles.l-1 , which were 24-fold greater than in control participants under general anaesthesia (744 (309-2106 [23-9099]) particles.l-1 , p < 0.001, n = 16). A substantial rise in aerosol also occurred with cardiac defibrillation and chest compressions. In a complimentary porcine model of cardiac arrest, aerosol recordings showed a strikingly similar profile to the human data. Time-averaged aerosol concentrations during ventilation were approximately 270-fold higher than before cardiac arrest (19,410 (2307-41,017 [104-136,025]) vs. 72 (41-136 [23-268]) particles.l-1 , p = 0.008). The porcine model also confirmed that both defibrillation and chest compressions generate high concentrations of aerosol independent of, but synergistic with, ventilation. In conclusion, multiple components of cardiopulmonary resuscitation generate high concentrations of respiratory aerosol. We recommend that airborne transmission precautions are warranted in the setting of high-risk pathogens, until the airway is secured with an airway device and breathing system with a filter.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
| | - V. Brown
- Critical Care, South Western Ambulance Service NHS Foundation TrustUK
- Great Western Air Ambulance CharityBristolUK
| | - J. Vassallo
- Institute of Naval MedicineGosportUK
- Academic Department of Military Emergency MedicineRoyal Centre for Defence MedicineBirminghamUK
| | - J. P. Nolan
- University of Warwick, Warwick Medical SchoolCoventryUK
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - J. Soar
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - F. Hamilton
- MRC Integrative Epidemiology UnitUniversity of BristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United HospitalBathUK
| | - B. R. Bzdek
- School of ChemistryUniversity of BristolBristolUK
| | - J. P. Reid
- School of ChemistryUniversity of BristolBristolUK
| | - C. H. Makepeace
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - J. Deutsch
- Langford Vets and Translational Biomedical Research CentreUniversity of BristolUK
| | - R. Ascione
- Translational Biomedical Research CentreUniversity of BristolBristolUK
- University Hospital Bristol Weston NHS TrustBristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - J. R. Benger
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
| | - A. E. Pickering
- Department of AnaesthesiaUniversity Hospitals Bristol and WestonBristolUK
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolBristolUK
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Hamilton V, Sheikh S, Szczepanska A, Maskell N, Hamilton F, Reid JP, Bzdek BR, Murray JRD. Diathermy and bone sawing are high aerosol yield procedures. Bone Joint Res 2023; 12:636-643. [PMID: 37813391 PMCID: PMC10562079 DOI: 10.1302/2046-3758.1210.bjr-2023-0028.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Abstract
Aims Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians' health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. Methods The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures. Results Diathermy (electrocautery) and oscillating bone saw use had a high aerosol yield (> 100 particles detected per s) consistent with high exposure to aerosol in the respirable range (< 5 µm) for the lead surgeon. Pulsed lavage, reaming, osteotome use, and jig application/removal were medium aerosol yield (10 to 100 particles s-1). However, pulsed lavage aerosol was largely attributed to the saline jet, osteotome use was always brief, and jig application/removal had a large variability in the associated aerosol yield. Suctioning (with/without saline irrigation) had a low aerosol yield (< 10 particles s-1). Most surprisingly, other high-speed procedures, such as drilling and screwing, had low aerosol yields. Conclusion This work suggests that additional precautions should be recommended for diathermy and bone sawing, such as enhanced personal protective equipment or the use of suction devices to reduce exposure.
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Affiliation(s)
| | | | | | - Nick Maskell
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - James R. D. Murray
- Bristol Medical School, University of Bristol, Bristol, UK
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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4
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Harrison S, Davies E, Shelton C. Aerosol-generating procedures: research, guidance and implementation. Anaesthesia 2023; 78:150-154. [PMID: 36196792 DOI: 10.1111/anae.15878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 01/11/2023]
Affiliation(s)
- S Harrison
- North West School of Anaesthesia, Manchester, UK
| | - E Davies
- North West School of Anaesthesia, Manchester, UK
| | - C Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
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Monroe LW, Johnson JS, Gutstein HB, Lawrence JP, Lejeune K, Sullivan RC, Jen CN. Preventing spread of aerosolized infectious particles during medical procedures: A lab-based analysis of an inexpensive plastic enclosure. PLoS One 2022; 17:e0273194. [PMID: 36137079 PMCID: PMC9499281 DOI: 10.1371/journal.pone.0273194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
Severe viral respiratory diseases, such as SARS-CoV-2, are transmitted through aerosol particles produced by coughing, talking, and breathing. Medical procedures including tracheal intubation, extubation, dental work, and any procedure involving close contact with a patient's airways can increase exposure to infectious aerosol particles. This presents a significant risk for viral exposure of nearby healthcare workers during and following patient care. Previous studies have examined the effectiveness of plastic enclosures for trapping aerosol particles and protecting health-care workers. However, many of these enclosures are expensive or are burdensome for healthcare workers to work with. In this study, a low-cost plastic enclosure was designed to reduce aerosol spread and viral transmission during medical procedures, while also alleviating issues found in the design and use of other medical enclosures to contain aerosols. This enclosure is fabricated from clear polycarbonate for maximum visibility. A large single-side cutout provides health care providers with ease of access to the patient with a separate cutout for equipment access. A survey of medical providers in a local hospital network demonstrated their approval of the enclosure's ease of use and design. The enclosure with appropriate plastic covers reduced total escaped particle number concentrations (diameter > 0.01 μm) by over 93% at 8 cm away from all openings. Concentration decay experiments indicated that the enclosure without active suction should be left on the patient for 15-20 minutes following a tracheal manipulation to allow sufficient time for >90% of aerosol particles to settle upon interior surfaces. This decreases to 5 minutes when 30 LPM suction is applied. This enclosure is an inexpensive, easily implemented additional layer of protection that can be used to help contain infectious or otherwise potentially hazardous aerosol particles while providing access into the enclosure.
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Affiliation(s)
- Luke W. Monroe
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Jack S. Johnson
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Howard B. Gutstein
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - John P. Lawrence
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Keith Lejeune
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA, United States of America
| | - Ryan C. Sullivan
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Coty N. Jen
- Center for Atmospheric Particle Studies, Carnegie Mellon University, Pittsburgh, PA, United States of America
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6
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Shrimpton AJ, Pickering AE. Aerosols: time to clear the air? Anaesthesia 2022; 77:1193-1196. [DOI: 10.1111/anae.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience University of Bristol UK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience University of Bristol UK
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Shrimpton AJ, Osborne CED, Brown JM, Cook TM, Penfold C, Rooshenas L, Pickering AE. Anaesthetists' current practice and perceptions of aerosol-generating procedures: a mixed-methods study. Anaesthesia 2022; 77:959-970. [PMID: 35864419 PMCID: PMC9543704 DOI: 10.1111/anae.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 01/11/2023]
Abstract
The evidence base surrounding the transmission risk of 'aerosol-generating procedures' has evolved primarily through quantification of aerosol concentrations during clinical practice. Consequently, infection prevention and control guidelines are undergoing continual reassessment. This mixed-methods study aimed to explore the perceptions of practicing anaesthetists regarding aerosol-generating procedures. An online survey was distributed to the Membership Engagement Group of the Royal College of Anaesthetists during November 2021. The survey included five clinical scenarios to identify the personal approach of respondents to precautions, their hospital's policies and the associated impact on healthcare provision. A purposive sample was selected for interviews to explore the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed thematically. The sample was broadly representative of the UK anaesthetic workforce. Most respondents and their hospitals were aware of, supported and adhered to UK guidance. However, there were examples of substantial divergence from these guidelines at both individual and hospital level. For example, 40 (12%) requested respiratory protective equipment and 63 (20%) worked in hospitals that required it to be worn whilst performing tracheal intubation in SARS-CoV-2 negative patients. Additionally, 173 (52%) wore respiratory protective equipment whilst inserting supraglottic airway devices. Regarding the use of respiratory protective equipment and fallow times in the operating theatre: 305 (92%) perceived reduced efficiency; 376 (83%) perceived a negative impact on teamworking; 201 (64%) were worried about environmental impact; and 255 (77%) reported significant problems with communication. However, 269 (63%) felt the negative impacts of respiratory protection equipment were appropriately balanced against the risks of SARS-CoV-2 transmission. Attitudes were polarised about the prospect of moving away from using respiratory protective equipment. Participants' perceived risk from COVID-19 correlated with concern regarding stepdown (Spearman's test, R = 0.36, p < 0.001). Attitudes towards aerosol-generating procedures and the need for respiratory protective equipment are evolving and this information can be used to inform strategies to facilitate successful adoption of revised guidelines.
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Affiliation(s)
- A. J. Shrimpton
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolUK
| | - C. E. D. Osborne
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolUK
| | - J. M. Brown
- Department of Anaesthesia and Intensive Care MedicineNorth Bristol NHS TrustBristolUK
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care MedicineRoyal United Hospital NHS TrustBathUK
| | - C. Penfold
- NIHR Bristol Biomedical Research CentreUniversity Hospitals Bristol and Weston NHS Foundation Trust and University of BristolUK
| | - L. Rooshenas
- Bristol Medical School, Bristol Population Health Science InstituteUniversity of BristolUK
| | - A. E. Pickering
- Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and NeuroscienceUniversity of BristolUK
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8
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Shrimpton AJ, Brown JM, Cook TM, Penfold CM, Reid JP, Pickering AE. Quantitative evaluation of aerosol generation from upper airway suctioning assessed during tracheal intubation and extubation sequences in anaesthetized patients. J Hosp Infect 2022; 124:13-21. [PMID: 35276282 PMCID: PMC9172909 DOI: 10.1016/j.jhin.2022.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Open respiratory suctioning is defined as an aerosol generating procedure (AGP). Laryngopharyngeal suctioning, used to clear secretions during anaesthesia, is widely managed as an AGP. However, it is uncertain whether upper airway suctioning should be designated as an AGP due to the lack of both aerosol and epidemiological evidence. AIM To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients. METHODS This prospective environmental monitoring study was undertaken in an ultraclean operating theatre setting to assay aerosol concentrations during intubation and extubation sequences, including upper airway suctioning, for patients undergoing surgery (N=19). An optical particle sizer (particle size 0.3-10 μm) sampled aerosol 20 cm above the patient's mouth. Baseline recordings (background, tidal breathing and volitional coughs) were followed by intravenous induction of anaesthesia with neuromuscular blockade. Four periods of laryngopharyngeal suctioning were performed with a Yankauer sucker: pre-laryngoscopy, post-intubation, pre-extubation and post-extubation. FINDINGS Aerosol was reliably detected {median 65 [interquartile range (IQR) 39-259] particles/L} above background [median 4.8 (IQR 1-7) particles/L, P<0.0001] when sampling in close proximity to the patient's mouth during tidal breathing. Upper airway suctioning was associated with a much lower average aerosol concentration than breathing [median 6.0 (IQR 0-12) particles/L, P=0.0007], and was indistinguishable from background (P>0.99). Peak aerosol concentrations recorded during suctioning [median 45 (IQR 30-75) particles/L] were much lower than during volitional coughs [median 1520 (IQR 600-4363) particles/L, P<0.0001] and tidal breathing [median 540 (IQR 300-1826) particles/L, P<0.0001]. CONCLUSION Upper airway suctioning during airway management was not associated with a higher aerosol concentration compared with background, and was associated with a much lower aerosol concentration compared with breathing and coughing. Upper airway suctioning should not be designated as a high-risk AGP.
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Affiliation(s)
- A J Shrimpton
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - C M Penfold
- Bristol Biomedical Research Centre, University of Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Anaesthesia, Pain and Critical Care, School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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Bhatia K. Obstetric analgesia and anaesthesia in SARS-CoV-2-positive parturients across 10 maternity units in the north-west of England: a retrospective cohort study. Anaesthesia 2022; 77:389-397. [PMID: 35226768 PMCID: PMC9111485 DOI: 10.1111/anae.15672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/11/2022]
Abstract
Since the start of the COVID-19 pandemic, few studies have reported anaesthetic outcomes in parturients with SARS-CoV-2 infection. We reviewed the labour analgesic and anaesthetic interventions utilised in symptomatic and asymptomatic parturients who had a confirmed positive test for SARS-CoV-2 across 10 hospitals in the north-west of England between 1 April 2020 and 31 May 2021. Primary outcomes analysed included the analgesic/anaesthetic technique utilised for labour and caesarean birth. Secondary outcomes included a comparison of maternal characteristics, caesarean birth rate, maternal critical care admission rate along with adverse composite neonatal outcomes. A positive SARS-CoV-2 test was recorded in 836 parturients with 263 (31.4%) reported to have symptoms of COVID-19. Neuraxial labour analgesia was utilised in 104 (20.4%) of the 509 parturients who went on to have a vaginal birth. No differences in epidural analgesia rates were observed between symptomatic and asymptomatic parturients (OR 1.03, 95%CI 0.64-1.67; p = 0.90). The neuraxial anaesthesia rate in 310 parturients who underwent caesarean delivery was 94.2% (95%CI 90.6-96.0%). The rates of general anaesthesia were similar in symptomatic and asymptomatic parturients (6% vs. 5.7%; p = 0.52). Symptomatic parturients were more likely to be multiparous (OR 1.64, 95%CI 1.19-2.22; p = 0.002); of Asian ethnicity (OR 1.54, 1.04-2.28; p = 0.03); to deliver prematurely (OR 2.16, 95%CI 1.47-3.19; p = 0.001); have a higher caesarean birth rate (44.5% vs. 33.7%; OR 1.57, 95%CI 1.16-2.12; p = 0.008); and a higher critical care utilisation rate both pre- (8% vs. 0%, p = 0.001) and post-delivery (11% vs. 3.5%; OR 3.43, 95%CI 1.83-6.52; p = 0.001). Eight neonates tested positive for SARS-CoV-2 while no differences in adverse composite neonatal outcomes were observed between those born to symptomatic and asymptomatic mothers (25.8% vs. 23.8%; OR 1.11, 95%CI 0.78-1.57; p = 0.55). In women with COVID-19, non-neuraxial analgesic regimens were commonly utilised for labour while neuraxial anaesthesia was employed for the majority of caesarean births. Symptomatic women with COVID-19 are at increased risk of significant maternal morbidity including preterm birth, caesarean birth and peripartum critical care admission.
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Affiliation(s)
- K. Bhatia
- Manchester University NHS Foundation TrustManchesterUK
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10
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Peterson MB, Gurnaney HG, Disma N, Matava C, Jagannathan N, Stein ML, Liu H, Kovatsis PG, von Ungern‐Sternberg BS, Fiadjoe JE. Complications associated with paediatric airway management during the COVID-19 pandemic: an international, multicentre, observational study. Anaesthesia 2022; 77:649-658. [PMID: 35319088 PMCID: PMC9111470 DOI: 10.1111/anae.15716] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/26/2022] [Accepted: 03/02/2022] [Indexed: 01/10/2023]
Abstract
Respiratory adverse events in adults with COVID-19 undergoing general anaesthesia can be life-threatening. However, there remains a knowledge gap about respiratory adverse events in children with COVID-19. We created an international observational registry to collect airway management outcomes in children with COVID-19 who were having a general anaesthetic. We hypothesised that children with confirmed or suspected COVID-19 would experience more hypoxaemia and complications than those without. Between 3 April 2020 and 1 November 2020, 78 international centres participated. In phase 1, centres collected outcomes on all children (age ≤ 18 y) having a general anaesthetic for 2 consecutive weeks. In phase 2, centres recorded outcomes for children with test-confirmed or suspected COVID-19 (based on symptoms) having a general anaesthetic. We did not study children whose tracheas were already intubated. The primary outcome was the incidence of hypoxaemia during airway management. Secondary outcomes included: incidence of other complications; and first-pass success rate for tracheal intubation. In total, 7896 children were analysed (7567 COVID-19 negative and 329 confirmed or presumed COVID-19 positive). The incidence of hypoxaemia during airway management was greater in children who were COVID-19 positive (24 out of 329 (7%) vs. 214 out of 7567 (3%); OR 2.70 (95%CI 1.70-4.10)). Children who had symptoms of COVID-19 had a higher incidence of hypoxaemia compared with those who were asymptomatic (9 out of 51 (19%) vs. 14 out of 258 (5%), respectively; OR 3.7 (95%CI 1.5-9.1)). Children with confirmed or presumed COVID-19 have an increased risk of hypoxaemia during airway management in conjunction with general anaesthesia.
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Affiliation(s)
- M. B. Peterson
- Department of AnesthesiologyChildren's Hospital Colorado/University of Colorado School of MedicineAuroraCOUSA
| | - H. G. Gurnaney
- Department of Anesthesiology and Critical Care MedicineThe Children's Hospital of Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
| | - N. Disma
- Unit for Research and Innovation, Department of Pediatric AnesthesiaIstituto Giannina GasliniGenovaItaly
| | - C. Matava
- Department of Anesthesia and Pain MedicineHospital for Sick ChildrenTorontoONCanada
| | - N. Jagannathan
- Ann and Robert Lurie Children's Hospital of Chicago/Northwestern UniversityChicagoILUSA
| | - M. L. Stein
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - H. Liu
- Data Science and Biostatistics Unit, Department of Biomedical and HealthThe Children's Hospital of PhiladelphiaPhiladelphiaPAUSA
| | - P. G. Kovatsis
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
| | - B. S. von Ungern‐Sternberg
- Department of Anesthesia and Pain MedicinePerth Children's Hospital, Telethon Kids Institute, The University of Western AustraliaPerthAustralia
| | - J. E. Fiadjoe
- Department of Anesthesiology and Critical Care MedicineThe Children's Hospital of Philadelphia and Perelman School of Medicine, University of PennsylvaniaPhiladelphiaPAUSA
- Department of Anesthesiology, Critical Care and Pain MedicineBoston Children's Hospital, Harvard Medical SchoolBostonMAUSA
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11
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Pope C, Harrop-Griffiths W, Brown J. Aerosol-generating procedures and the anaesthetist. BJA Educ 2022; 22:52-59. [PMID: 35035993 PMCID: PMC8749387 DOI: 10.1016/j.bjae.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- C. Pope
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK,Corresponding author:
| | | | - J. Brown
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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