From the Guidelines
Droplets can indeed spread when a patient is on a ventilator, posing a significant risk of transmission to healthcare workers and others nearby. This is because mechanical ventilation involves the use of endotracheal tubes and ventilator circuits that can generate aerosols and droplets during procedures like intubation, extubation, suctioning, and circuit disconnections 1. According to the consensus guidelines for managing the airway in patients with COVID-19, transmission is thought to be predominantly by droplet spread, and direct contact with the patient or contaminated surfaces (fomites), rather than airborne spread 1.
Key Considerations
- The use of endotracheal tubes and ventilator circuits can generate aerosols and droplets that may contain infectious agents if the patient has a respiratory infection 1.
- Healthcare workers should use appropriate personal protective equipment (PPE) including N95 respirators or higher, eye protection, gowns, and gloves when caring for ventilated patients, especially those with known or suspected respiratory infections.
- Additional precautions include using closed suction systems, minimizing circuit disconnections, and placing bacterial/viral filters on the expiratory limb of the ventilator circuit 1.
- Proper room ventilation with negative pressure rooms for infectious patients can further reduce the risk of droplet spread.
Recommendations
- Healthcare workers should take extra precautions when performing procedures that may generate aerosols, such as tracheal intubation, tracheal extubation, tracheostomy insertion, tracheal suction, airway endoscopy, bronchoscopy, and mask ventilation 1.
- Strategies to reduce coughing, reduce positive pressure delivered to an unsealed airway, and reduce exposure to respiratory droplets are recommended 1.
From the Research
Droplet Spread in Ventilated Patients
- The spread of droplets in patients on ventilation is a complex topic, and research is ongoing to understand the mechanisms and risks involved 2, 3.
- Studies have shown that ventilator-associated pneumonia (VAP) is a significant concern in patients on mechanical ventilation, and the use of heat and moisture exchanger (HME) filters and heated humidifiers can affect the incidence of VAP 4.
- However, the specific question of whether droplets can spread when a patient is on a ventilator is not directly addressed in the provided studies.
- Research on aerosol transmission of severe acute respiratory syndrome coronavirus 2 suggests that fit-tested N95 masks and portable high-efficiency particulate air (HEPA) filtration can protect against high aerosolized viral loads over prolonged periods at close range 5.
- The management of respiratory failure and ventilator management are critical aspects of patient care, and understanding the basic principles of invasive and noninvasive mechanical ventilation is essential for healthcare professionals 3, 6.