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Research ArticleFast Track

Risk of Aerosol Formation During High-Flow Nasal Cannula Treatment in Critically Ill Subjects

Reinout A Bem, Niels van Mourik, Rozalinde Klein-Blommert, Ingrid JB Spijkerman, Stefan Kooij, Daniel Bonn and Alexander P Vlaar
Respiratory Care June 2021, 66 (6) 891-896; DOI: https://doi.org/10.4187/respcare.08756
Reinout A Bem
Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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  • For correspondence: [email protected]
Niels van Mourik
Department of Adult Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Rozalinde Klein-Blommert
Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Ingrid JB Spijkerman
Department of Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Stefan Kooij
Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, The Netherlands.
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Daniel Bonn
Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, The Netherlands.
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Alexander P Vlaar
Department of Adult Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
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Abstract

BACKGROUND: There is a persistent concern over the risk of respiratory pathogen transmission, including SARS-CoV-2, via the formation of aerosols (ie, a suspension of microdroplets and residual microparticles after evaporation) generated during high-flow nasal cannula (HFNC) oxygen therapy in critically ill patients. This concern is fueled by limited available studies on this subject. In this study, we tested our hypothesis that HFNC treatment is not associated with increased aerosol formation as compared to conventional oxygen therapy.

METHODS: We used laser light scattering and a handheld particle counter to detect and quantify aerosols in healthy subjects and in adults with acute respiratory disease, including COVID-19, during HFNC or conventional oxygen therapy.

RESULTS: The use of HFNC was not associated with increased formation of aerosols as compared to conventional oxygen therapy in both healthy subjects (n = 3) and subjects with acute respiratory disease, including COVID-19 (n = 17).

CONCLUSIONS: In line with scarce previous clinical and experimental findings, our results indicate that HFNC itself does not result in overall increased aerosol formation as compared to conventional oxygen therapy. This suggests there is no increased risk of respiratory pathogen transmission to health care workers during HFNC.

  • high-flow nasal cannula
  • oxygen therapy
  • aerosol
  • respiratory virus
  • pneumonia
  • ARDS
  • COVID-19

Footnotes

  • Correspondence: Reinout A Bem MD PhD, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands. E-mail: r.a.bem{at}amsterdamumc.nl
  • See the Related Editorial on Page 1039

  • Drs Bem and van Mourik are co-first authors.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (6)
Respiratory Care
Vol. 66, Issue 6
1 Jun 2021
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Risk of Aerosol Formation During High-Flow Nasal Cannula Treatment in Critically Ill Subjects
Reinout A Bem, Niels van Mourik, Rozalinde Klein-Blommert, Ingrid JB Spijkerman, Stefan Kooij, Daniel Bonn, Alexander P Vlaar
Respiratory Care Jun 2021, 66 (6) 891-896; DOI: 10.4187/respcare.08756

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Risk of Aerosol Formation During High-Flow Nasal Cannula Treatment in Critically Ill Subjects
Reinout A Bem, Niels van Mourik, Rozalinde Klein-Blommert, Ingrid JB Spijkerman, Stefan Kooij, Daniel Bonn, Alexander P Vlaar
Respiratory Care Jun 2021, 66 (6) 891-896; DOI: 10.4187/respcare.08756
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Keywords

  • High-flow nasal cannula
  • oxygen therapy
  • aerosol
  • respiratory virus
  • pneumonia
  • ARDS
  • COVID-19

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