Pleural procedures not aerosol generating, researchers conclude


By Emma Wilkinson

20 Jul 2021

Pleural procedures such as chest drains and thoracoscopy do not need to be classed as aerosol generating in relation to transmission risk of SARS-CoV-2, say UK researchers.

A study looking at aerosol emissions in several pleural procedures found that in most procedures, the peak aerosol concentration was of similar magnitude to or less than the mean during breathing from the same patients or from healthy volunteers.

It was also significantly less than the peak aerosol concentration detected from a cough.

The Bristol researchers also found that percutaneous instrumentation of the pleura does not lead to significant aerosol generation. 

In fact, total aerosol generation during these procedures was significantly below the number concentration produced by breathing or coughing. 

 The study was part of work being done by NIHR researchers as part of the AERATOR study.

British Thoracic Society guidelines had noted the absence of evidence but had been based on the precautionary principle suggesting that closed pleural procedures such as pleural aspirations and chest drain insertion could be done in level 1 PPE but that open procedures required level 2 PPE which is an FFP3 mask, long-sleeved gown, gloves and eye protection. 

Writing in the European Respiratory Journal, the researchers did note that pleural procedures, especially those that generate a negative intrathoracic pressure such as therapeutic thoracentesis, can induce a cough in patients and they would recommend they be asked to wear a surgical facemask.

Speaking with the limbic, study leader Dr David Arnold, an NIHR Doctoral Research Fellow at the University of Bristol said:Until now it was felt that pleural procedures had a theoretical risk of aerosolising SARS-CoV-2.  Therefore, it was advised that procedures were carried out in full PPE and with fallow periods between procedures – making the procedures more difficult and taking longer between cases. 

“We have shown definitively that aerosols are not generated by these procedures which is very encouraging.”

 He added: “This should inform respiratory guidelines by stating that pleural procedures do not need to be classed as aerosol generating procedures. 

“Pleural procedures can be performed as they were prior to the pandemic which takes pressure off already stretched respiratory medical doctors.”

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