Aerosol-generating Procedures in Patients with COVID-19: A Narrative Review

Abstract

Severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. Transmission of SARS-CoV-2 is thought to be predominantly through respiratory spread of aerosols. Aerosol-generating procedures (AGPs) include various anesthesia or intensive care techniques, such as facemask ventilation, tracheal intubation, tracheal extubation, insertion or removal of the supraglottic airway, tracheostomy, high-flow oxygen delivery, and removal of oropharyngeal or tracheal secretion by suction. AGPs are high at risk of viral infection for the healthcare worker, and special care during airway management would be required as most airway management are closely related to AGPs. Some simulation studies have indicated that facemask ventilation and coughing after extubation may increase the risk of healthcare workers being exposed to a higher concentration of viral aerosols compared to other AGPs. The current state of knowledge indicates that wearing standard personal protective equipment, using an aerosol extractor with a virus filter, choice of tracheal intubation at rapid sequence induction, and video laryngoscope to intubate the trachea have efficacy in protecting healthcare workers from the viral transmission during airway management.