Classification of aerosol-generating procedures: a rapid systematic review
In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. W...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/7/1/e000730.full |
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| author | Kamlesh Khunti Nia Roberts Elaine Toomey Quentin Durand-Moreau Trisha Greenhalgh Simon Smith Tanya Jackson Danika Deibert Graeme Wyatt Anil Adisesh Sachin Khunti Xin Hui S Chan Lawrence Ross Isheeta Arora Susannah M Black Jonathan Drake Nandana Syam Robert Temple Sebastian Straube |
| author_facet | Kamlesh Khunti Nia Roberts Elaine Toomey Quentin Durand-Moreau Trisha Greenhalgh Simon Smith Tanya Jackson Danika Deibert Graeme Wyatt Anil Adisesh Sachin Khunti Xin Hui S Chan Lawrence Ross Isheeta Arora Susannah M Black Jonathan Drake Nandana Syam Robert Temple Sebastian Straube |
| author_sort | Kamlesh Khunti |
| collection | DOAJ |
| description | In the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures. |
| format | Article |
| id | doaj-art-0fea32b725564a5d89c3d123117aa433 |
| institution | OA Journals |
| issn | 2052-4439 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj-art-0fea32b725564a5d89c3d123117aa4332025-08-20T02:10:50ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392020-12-017110.1136/bmjresp-2020-000730Classification of aerosol-generating procedures: a rapid systematic reviewKamlesh Khunti0Nia Roberts1Elaine Toomey2Quentin Durand-Moreau3Trisha Greenhalgh4Simon Smith5Tanya Jackson6Danika Deibert7Graeme Wyatt8Anil Adisesh9Sachin Khunti10Xin Hui S Chan11Lawrence Ross12Isheeta Arora13Susannah M Black14Jonathan Drake15Nandana Syam16Robert Temple17Sebastian Straube18Department of Health Sciences, University of Leicester, Leicester, UKBodleian Health Care Libraries, University of Oxford, Oxford, UKEvidence Synthesis Ireland and Cochrane Ireland, College of Medicine Nursing and Health Science, University of Galway, Galway, IrelandDivision of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canadaprofessor of Primary Care Health SciencesQuality Improvement EditorDivision of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaDivision of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaDivision of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaDivision of Occupational Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, CanadaSchool of Medicine and Dentistry, Barts and the London School of Medicine and Dentistry, London, UKCentre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, Oxfordshire, UKDivision of Infectious Diseases, Children’s Hospital of Los Angeles, Los Angeles, California, USAMedical Sciences Division, University of Oxford, Oxford, Oxfordshire, UKMedical Sciences Division, University of Oxford, Oxford, Oxfordshire, UKMedical Sciences Division, University of Oxford, Oxford, Oxfordshire, UKMedical Sciences Division, University of Oxford, Oxford, Oxfordshire, UKMedical Sciences Division, University of Oxford, Oxford, Oxfordshire, UKDivision of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, CanadaIn the context of covid-19, aerosol generating procedures have been highlighted as requiring a higher grade of personal protective equipment. We investigated how official guidance documents and academic publications have classified procedures in terms of whether or not they are aerosol-generating. We performed a rapid systematic review using preferred reporting items for systematic reviews and meta-analyses standards. Guidelines, policy documents and academic papers published in english or french offering guidance on aerosol-generating procedures were eligible. We systematically searched two medical databases (medline, cochrane central) and one public search engine (google) in march and april 2020. Data on how each procedure was classified by each source were extracted. We determined the level of agreement across different guidelines for each procedure group, in terms of its classification as aerosol generating, possibly aerosol-generating, or nonaerosol-generating. 128 documents met our inclusion criteria; they contained 1248 mentions of procedures that we categorised into 39 procedure groups. Procedures classified as aerosol-generating or possibly aerosol-generating by ≥90% of documents included autopsy, surgery/postmortem procedures with high-speed devices, intubation and extubation procedures, bronchoscopy, sputum induction, manual ventilation, airway suctioning, cardiopulmonary resuscitation, tracheostomy and tracheostomy procedures, non-invasive ventilation, high-flow oxygen therapy, breaking closed ventilation systems, nebulised or aerosol therapy, and high frequency oscillatory ventilation. Disagreements existed between sources on some procedure groups, including oral and dental procedures, upper gastrointestinal endoscopy, thoracic surgery and procedures, and nasopharyngeal and oropharyngeal swabbing. There is sufficient evidence of agreement across different international guidelines to classify certain procedure groups as aerosol generating. However, some clinically relevant procedures received surprisingly little mention in our source documents. To reduce dissent on the remainder, we recommend that (a) clinicians define procedures more clearly and specifically, breaking them down into their constituent components where possible; (b) researchers undertake further studies of aerosolisation during these procedures; and (c) guideline-making and policy-making bodies address a wider range of procedures.https://bmjopenrespres.bmj.com/content/7/1/e000730.full |
| spellingShingle | Kamlesh Khunti Nia Roberts Elaine Toomey Quentin Durand-Moreau Trisha Greenhalgh Simon Smith Tanya Jackson Danika Deibert Graeme Wyatt Anil Adisesh Sachin Khunti Xin Hui S Chan Lawrence Ross Isheeta Arora Susannah M Black Jonathan Drake Nandana Syam Robert Temple Sebastian Straube Classification of aerosol-generating procedures: a rapid systematic review BMJ Open Respiratory Research |
| title | Classification of aerosol-generating procedures: a rapid systematic review |
| title_full | Classification of aerosol-generating procedures: a rapid systematic review |
| title_fullStr | Classification of aerosol-generating procedures: a rapid systematic review |
| title_full_unstemmed | Classification of aerosol-generating procedures: a rapid systematic review |
| title_short | Classification of aerosol-generating procedures: a rapid systematic review |
| title_sort | classification of aerosol generating procedures a rapid systematic review |
| url | https://bmjopenrespres.bmj.com/content/7/1/e000730.full |
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