An In Vitro Investigation of the Release of Fugitive Medical Aerosols into the Environment during Manual Ventilation.

Mac Giolla Eain, Marc; Joyce, Mary; O'Sullivan, Andrew; McGrath, James A; MacLoughlin, Ronan

BACKGROUND During manual resuscitation nebuliser therapy may be used to deliver therapeutics to patients in respiratory distress. However, the devices used to generate and deliver these medical aerosols have the potential to release these therapeutics into the local environment and expose caregivers to unwanted medical aerosols. AIM To quantify the levels of fugitive medical aerosol released into the environment during aerosol drug delivery using a manual resuscitation bag with and without filtration. METHODS Time-varying fugitive aerosol concentrations were measured using an aerodynamic particle sizer placed at a position designed to mimic a caregiver. Two nebuliser types were assessed, a vibrating mesh nebuliser and a jet nebuliser. The aerosol dose delivered to the simulated patient lung was also quantified. FINDINGS AND CONCLUSIONS Filtration of the exhalation port of the manual resuscitation bag was seen to reduce fugitive medical aerosols to ambient levels for both nebuliser types. The vibrating mesh nebuliser delivered the greatest quantity of aerosol to the simulated adult patient (18.44 ± 1.03% versus 3.64 ± 0.26% with a jet nebuliser). The results highlight the potential for exposure to fugitive medical aerosols released during the delivery of aerosol therapy with a manual resuscitation bag and also the potential for significant variation in patient lung dose depending on nebuliser type.