Indian Journal of Respiratory Care

IJRC Email      Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  13 (2024)
Volume  12 (2023)
Volume  11 (2022)
Volume  10 (2021)
Volume  9 (2020)
Volume  8 (2019)
Volume  7 (2018)
Volume  6 (2017)
Volume  5 (2016)
Volume  4 (2015)
Volume  3 (2014)
Volume  2 (2013)
Volume  1 (2012)
Related articles

VOLUME 5 , ISSUE 1 ( January-June, 2016 ) > List of Articles

Original Article

Secondhand aerosol exposure during mechanical ventilation with and without expiratory filters: An in-vitro study

Arzu Ari, James B Fink, Sue Pilbeam

Keywords : Aerosols, mechanical ventilation, secondhand aerosol exposure, and inhalation therapy

Citation Information : Ari A, Fink JB, Pilbeam S. Secondhand aerosol exposure during mechanical ventilation with and without expiratory filters: An in-vitro study. Indian J Respir Care 2016; 5 (1):677-682.

DOI: 10.5005/jp-journals-11010-05103

License: NA

Published Online: 02-12-2022

Copyright Statement:  NA


Abstract

Background: Concerns have been expressed about risk of exposure to exhaled aerosols to ICU personnel. AIM: To quantify amount of aerosol collected at the exhaust outlet of mechanical ventilators operated with and without filters in the expiratory limb. Methods: Two categories of ventilators were tested: (1) Ventilators without Proprietary Filters: Servo-i (Maquet) and Galileo (Hamilton) and (2) Ventilator with proprietary filters: PB 840 (Covidien). Each ventilator was attached to a simple test lung and operated with VT 500 ml, RR 20 bpm, PIF 50 L/min, PEEP 5 cmH2O. Four separate doses of albuterol (2.5 mg/3mL) were administered via jet nebuliser (eValueMed, Tri-anim) placed at the “Y”. In Experiment A, a filter (Respirgard 303) was placed at the exhaust port. In Experiment B, two filters were attached to the ventilators without proprietary filters: (1) at the end of expiratory limb and (2) at the exhaust outlet. Drug was eluted from filters and measured using spectrophotometry. Results: Drug deposited at the exhaust port without expiratory filtering was >160 fold higher than with expiratory filtering. The collecting filter used in this study was less efficient than the proprietary filter designed for use with the ventilator. Regardless of type of filter used, placement of filter in the expiratory limb reduced secondhand aerosol exposure significantly. Conclusion: Risk of secondhand exposure to exhaled aerosol can account for >45% of nominal dose as well as droplet nuclei produced by patients. Using expiratory filters decreases risk of exposure to aerosol released to the atmosphere during mechanical ventilation.

HTML PDF Share
  1. Mapp CE, Boschetto P, Maestrelli P, Fabbri LM. Occupational asthma. Am J Respir Crit Care Med. 2005;172(3):280-305.
  2. Dimich-Ward H, Wymer ML, Chan-Yeung M. Respiratory health survey of respiratory therapists. Chest. 2004;126(4):1048-53
  3. Gannon PF, Bright P, Campbell M, O’Hickey SP, Burge PS. Occupational asthma due to glutaraldehyde and formaldehyde in endoscopy and x ray departments. Thorax. 1995;50(2):156-9
  4. Nagy L, Orosz M. Occupational asthma due to hexachlorophene. Thorax. 1984;39(8):630-
  5. Hendrick DJ, Lane DJ. Formalin asthma in hospital staff. Br Med J. 1975;1(5958):607-8.
  6. Lefcoe NM, Wonnacott TH. The prevalence of chronic respiratory disease in the male physicians of London, Ontario. Can Med Assoc J. 1970;102(4):381-5.
  7. Bardy JD, Malo JL, Seguin P, et al. Occupational asthma and IgE sensitization in a pharmaceutical company processing psyllium. Am Rev Respir Dis. 1987;135(5):1033-8.
  8. Christiani DC, Kern DG. Asthma risk and occupation as a respiratory therapist. Am Rev Respir Dis. 1993;148(3):671-4.
  9. Meredith SK, Taylor VM, McDonald JC. Occupational respiratory disease in the United Kingdom 1989: a report to the British Thoracic Society and the Society of Occupational Medicine by the SWORD project group. Br J Ind Med. 1991;48(5):292-8.
  10. de la Hoz RE, Young RO, Pedersen DH. Exposure to potential occupational asthmogens: prevalence data from the National Occupational Exposure Survey. Am J Ind Med. 1997;31(2):195-201.
  11. Pechter E, Davis LK, Tumpowsky C, et al. Work-related asthma among health care workers: surveillance data from California, Massachusetts, Michigan, and New Jersey, 1993-1997. Am J Ind Med. 2005;47(3):265-75.
  12. Blanc PD, Burney P, Janson C, Toren K. The prevalence and predictors of respiratory-related work limitation and occupational disability in an international study. Chest. 2003;124(3):1153-9.
  13. Arif AA, Delclos GL, Whitehead LW, Tortolero SR, Lee ES. Occupational exposures associated with work-related asthma and work-related wheezing among U.S. workers. Am J Ind Med. 2003;44(4):368-6.
  14. Delclos GL, Gimeno D, Arif AA, et al. Occupational risk factors and asthma among health care professionals. Am J Respir Crit Care Med. 2007;175(7):667-75.
  15. Kern DG, Frumkin H. Asthma in respiratory therapists. Ann Intern Med. 1989;110(10):767-73.
  16. Carnathan B, Martin B, Colice G. Second Hand (S)-albuterol: RT exposure risk following racemic albuterol. Respiratory Care. 2001;46:1084.
  17. Blanc PD, Ellbjar S, Janson C, et al. Asthmarelated work disability in Sweden. The impact of workplace exposures. Am J Respir Crit Care Med. 1999;160(6):2028-33.
  18. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med. 1992;326(13):862-6.
  19. Barnes PJ, Jonsson B, Klim JB. The costs of asthma. Eur Respir J. 1996;9(4):636-42.
  20. Welty C, Burstin S, Muspratt S, Tager IB. Epidemiology of tuberculous infection in a chronic care population. Am Rev Respir Dis. 1985;132(1):133-6.
  21. Malone JL, Ijaz K, Lambert L, et al. Investigation of healthcare-associated transmission of Mycobacterium tuberculosis among patients with malignancies at three hospitals and at a residential facility. Cancer.2004;101(12):2713-21.
  22. Hui DS, Hall SD, Chan MT, et al. Exhaled air dispersion during oxygen delivery via a simple oxygen mask. Chest. 2007;132(2):540-6.
  23. Hui DS, Ip M, Tang JW, et al. Airflows around oxygen masks: A potential source of infection? Chest. 2006;130(3):822-6.
  24. Hui DS, Hall SD, Chan MT, et al. Noninvasive positive-pressure ventilation: An experimental model to assess air and particle dispersion. Chest. 2006;130(3):730-40.
  25. Hui D, Chow B, Chu L, et al. Exhaled air and aerosolised droplet dispersion during application of a jet nebuliser. Chest. 2009;135(3):648-54.
  26. Eames I, Tang JW, Li Y, Wilson P. Airborne transmission of disease in hospitals. J R Soc Interface. 2009;6 Suppl 6:S697-702.
  27. Rau JL, Ari A, Restrepo RD. Performance comparison of nebuliser designs: constantoutput, breath-enhanced, and dosimetric. Respiratory Care. 2004;49(2):174-9.
  28. Shults RA, Baron S, Decker J, Deitchman SD, Connor JD. Health care worker exposure to aerosolised ribavirin: biological and air monitoring. J Occup Environ Med. 1996;38(3):257-63.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.