Generation of aerosols by noninvasive respiratory support modalities : a systematic review and meta-analysis
Zhang, Madeline X. ; Lilien, Thijs A. ; Van Etten-Jamaludin, Faridi S. ; Fraenkel, Carl Johan LU ; Bonn, Daniel ; Vlaar, Alexander P.J. ; Löndahl, Jakob LU
; Klompas, Michael
and Bem, Reinout A.
(2023)
In JAMA Network Open
6(10).
- Abstract
Importance: Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures.
Objective: To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation.
Data Sources: A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed.
Study Selection: Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected.... (More)
Importance: Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures.
Objective: To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation.
Data Sources: A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed.
Study Selection: Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected.
Data Extraction and Synthesis: Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice.
Main Outcomes and Measures: The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles.
Results: Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation.
Conclusions and Relevance: This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities..
(Less)
- author
- Zhang, Madeline X.
; Lilien, Thijs A.
; Van Etten-Jamaludin, Faridi S.
; Fraenkel, Carl Johan
LU
; Bonn, Daniel
; Vlaar, Alexander P.J.
; Löndahl, Jakob
LU
; Klompas, Michael
and Bem, Reinout A.
- organization
- publishing date
- 2023-10-11
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JAMA Network Open
- volume
- 6
- issue
- 10
- article number
- e2337258
- pages
- 12 pages
- publisher
- American Medical Association
- external identifiers
-
- pmid:37819660
- scopus:85175179647
- ISSN
- 2574-3805
- DOI
- 10.1001/jamanetworkopen.2023.37258
- language
- English
- LU publication?
- yes
- id
- 80bd0402-2073-481e-8aef-4c16052d8377
- date added to LUP
- 2023-11-08 16:15:47
- date last changed
- 2024-04-20 08:21:10
@article{80bd0402-2073-481e-8aef-4c16052d8377,
abstract = {{<p>Importance: Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. </p><p>Objective: To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. </p><p>Data Sources: A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. </p><p>Study Selection: Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. </p><p>Data Extraction and Synthesis: Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. </p><p>Main Outcomes and Measures: The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. </p><p>Results: Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. </p><p>Conclusions and Relevance: This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities..</p>}},
author = {{Zhang, Madeline X. and Lilien, Thijs A. and Van Etten-Jamaludin, Faridi S. and Fraenkel, Carl Johan and Bonn, Daniel and Vlaar, Alexander P.J. and Löndahl, Jakob and Klompas, Michael and Bem, Reinout A.}},
issn = {{2574-3805}},
language = {{eng}},
month = {{10}},
number = {{10}},
publisher = {{American Medical Association}},
series = {{JAMA Network Open}},
title = {{Generation of aerosols by noninvasive respiratory support modalities : a systematic review and meta-analysis}},
url = {{http://dx.doi.org/10.1001/jamanetworkopen.2023.37258}},
doi = {{10.1001/jamanetworkopen.2023.37258}},
volume = {{6}},
year = {{2023}},
}