Quantitative evaluation of aerosol generation from upper airway suctioning assessed during tracheal intubation and extubation sequences in anaesthetized patients

• Published in: The Journal of hospital infection 2022-06, Vol.124, p.13-21
• Main Authors: Shrimpton, A.J., Brown, J.M., Cook, T.M., Penfold, C.M., Reid, J.P., Pickering, A.E.
• Format: Article
• Language: English
• Subjects: Aerosol; Aerosols; Airway Extubation - methods; Cough; Humans; Intubation, Intratracheal; Open suctioning; Prospective Studies; Suction; Upper airway
• ISSN: 0195-6701; 1532-2939; 1532-2939
• DOI: 10.1016/j.jhin.2022.02.021

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. To assess the relative risk of aerosol generation by upper airway suctioning during tracheal intubation and extubation in anaesthetized patients. 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. Aerosol was reliably detected {median 65 [interquartile range (IQR) 39–259] particles/L} above background [median 4.8 (IQR 1–7) particles/L, P