Inra, M. L.

Lazzaro, R. S.

Patton, B.

English

Hofstra Northwell Academic Works (Hofstra Northwell School of Medicine)

Journal Articles 2021 Commentary: Covid 19: Don't Throw Caution to the Wind Nor Air Leak. Use PPE! R. S. Lazzaro Zucker School of Medicine at Hofstra/Northwell M. L. Inra B. Patton Zucker School of Medicine at Hofstra/Northwell Follow this and additional works at: https://academicworks.medicine.hofstra.edu/publications  Part of the Cardiology Commons Recommended Citation Lazzaro RS, Inra ML, Patton B. Commentary: Covid 19: Don't Throw Caution to the Wind Nor Air Leak. Use PPE!. . 2021 Jan 01; ():Article 7678 [ p.]. Available from: https://academicworks.medicine.hofstra.edu/publications/7678. Free full text article. This Article is brought to you for free and open access by Donald and Barbara Zucker School of Medicine Academic Works. It has been accepted for inclusion in Journal Articles by an authorized administrator of Donald and Barbara Zucker School of Medicine Academic Works. For more information, please contact academicworks@hofstra.edu.   Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website.  Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.  Commentary: Covid 19: Don’t Throw Caution tothe Wind Nor Air Leak. Use PPE!Richard S. Lazzaro, MD, FACS, Matthew L. Inra, MD, and Byron Patton, MDThis past year, the COVID-19 pandemic has upended thelives of nearly every person worldwide with millions ofreported cases and hundreds of thousands of deaths. As a novelvirus, little is known about its mode of transmission however,there is increasing evidence that airborne transmission viadroplets is an important factor but the role of aerosols remainscontroversial.1 Most experimental studies have focused onaerosol-generating procedures such as bronchoscopy, endotra-cheal intubation, and positive pressure ventilation via facemask. Personal protective equipment (PPE) is recommendedfor these procedures including gown, gloves, eye protection,and N-95 mask. Little evidence is available regarding the riskto healthcare workers in the special circumstance of a patientwith a chest tube and air leak.In this original article, Mustaev and colleagues sought todefine the degree of aerosolization from chest tube drainagesystems in the context of the COVID-19 pandemic.2 They con-ceptualized and developed a novel simulation model for mea-suring aerosol generation by agitating a fluorescent fluid withdifferent air flow rates. The aerosolized particles were measuredunder ultraviolet light. They concluded that the single chamberchest drainage system is much more likely to generate aerosolsthan a 3-chamber or digital drainage system and therefore, sin-gle chambers should not be used in patients with air leak.2Other researchers have detected that even loud speech can“emit thousands of oral fluid droplets per second” using highlysensitive laser light scattering observations.3 This technique andothers allow for measurement of droplets as small as 0.5 mm. Inthe authors’ study, the smallest droplet detected measured 56 mmwith a mean size of 152 mm suggesting that many smaller drop-lets may not have been detected with their simulation and thatthe degree of aerosol generation is underestimated.But merely demonstrating that speech or air leaks generateaerosols does not prove transmissibility. Infection is dependenton “the route of exposure, the size of the inoculum, the durationof the exposure, and host defenses.1” Another study aerosolizedSARS-CoV-2 and found that the virus “retained infectivity andvirion integrity for up to 16 hours in aerosols” and “may be amore important exposure transmission pathway than previouslyconsidered.4” The jury is still out on the impact of airborne trans-mission in the non-simulated, real world but these factors mustbe considered in protecting those at risk of exposure.While this article is immediately relevant to many thoracicsurgeons and other healthcare personnel across the globe, it isclear that PPE is required when in close proximity to patientswith suspected or proven COVID-19. These patients are atincreased risk of pneumothorax and bronchopleural fistularequiring chest tube drainage with prolonged air leaks. Threechamber or digital drainage systems should be used in this set-ting to minimize aerosolization and contamination of the envi-ronment but are not a substitute for PPE. Don’t throw cautionto the wind nor air leak.REFERENCES1. Klompas M, Baker MA, Rhee C: Airborne transmission of SARS-CoV-2:Theoretical considerations and available evidence. JAMA 324:441–442,20202. Mustaev M, Bille A, Hasan M, et al: Simulation and measurement of aeroso-lisation in different chest drainage Systems. Semin Thorac Cardiovasc Surg2020. https://doi.org/10.1053/j.semtcvs.2020.10.002. Epub ahead of print.PMID: 33171236; PMCID: PMC78338323. Stadnytskyi V, Bax CE, Bax A, et al: The airborne lifetime of small speechdroplets and their potential importance in SARS-CoV-2 transmission.PNAS 117:11875–11877, 20204. Fears AC, Klimstra WB, Duprex P, et al: Persistence of severe acute respira-tory syndrome coronavirus 2 in aerosol suspensions. Emerg Infect Dis26:2168–2171, 2020Richard S. Lazzaro, MD FACS; Matthew L. Inra, MD;Byron Patton, MD.Central MessageThree chamber or digital drainage systemsshould be used in patients with suspected orproven COVID-19 with air leaks to minimizeaerosolization and contamination of the envi-ronment but are not a substitute for PPE.Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York,New YorkConflicts of Interest: None.Address reprint requests to Richard Lazzaro, MD, Department of Car-diothoracic Surgery, Lenox Hill Hospital, 130 E 77th St, New York, NY10075 E-mail: rlazzaro@northwelll.eduDOI of original article: http://dx.doi.org/10.1053/j.semtcvs.2020.10.002.11043-0679/$see front matter © 2021 Elsevier Inc. All rights reserved.https://doi.org/10.1053/j.semtcvs.2020.12.022THORACIC  Commentary

Commentary: Covid 19: Don\u27t Throw Caution to the Wind Nor Air Leak. Use PPE!

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Commentary: Covid 19: Don\u27t Throw Caution to the Wind Nor Air Leak. Use PPE!

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