Abstract
ABSTRACT Background: During mechanical ventilation of a patient requiring ventilatory support, bystanders could potentially be exposed to aerosolised drug. Methods: Fugitive drug aerosol emissions during simulated adult mechanical ventilation was assessed on a dual limb circuit. Tidal volume was set at 270 mL and 820 mL. The use of a protective filter on the exhalation port of the mechanical ventilator was assessed. Results: Higher fugitive aerosol mass concentrations in the local environment were associated with larger tidal volume (0.077 (0.073, 0.091) mg m–3 at Vt = 820 mL vs. 0.062 (0.056, 0.065) mg m–3 at Vt = 270 mL) when no protective filter was used. The range of mass median aerodynamic diameters recorded was from 0.93 to 2.96 µm. When a filter was placed on the exhalation port of the mechanical ventilator, no fugitive emissions were recorded. Conclusion: This study confirms that an appropriate filtration protocol mitigates the risk of fugitive emissions being released when patients undergo aerosol therapy during mechanical ventilation. A larger tidal volume resulted in higher fugitive aerosol mass.
Highlights
Mechanical ventilation is a mainstay in the provision of ventilatory support in respiratory patients in receipt of critical care, delivering oxygen and maintaining airway pressures
Absence of Filter When there was No Filter (NF) on the exhalation port of the mechanical ventilator, aerosol mass concentrations increased during the nebulisation period (Fig. 3)
The Aerodynamic Particle Sizers (APS) at 0.8 m from the exhalation port of the mechanical ventilator detected higher aerosol mass concentrations consistently for each measurement compared to the APS located at a distance of 2.0 m when no filter is present on the exhalation port (Table 1 and Fig. 4)
Summary
Mechanical ventilation is a mainstay in the provision of ventilatory support in respiratory patients in receipt of critical care, delivering oxygen and maintaining airway pressures. It can be administered non-invasively, via tight fitting facemask or hood, or invasively via a tracheostomy or endotracheal tube. Results: Higher fugitive aerosol mass concentrations in the local environment were associated with larger tidal volume (0.077 (0.073, 0.091) mg m–3 at Vt = 820 mL vs 0.062 (0.056, 0.065) mg m–3 at Vt = 270 mL) when no protective filter was used. A larger tidal volume resulted in higher fugitive aerosol mass
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