key: cord-0015376-ha4nf2wy
authors: Brunelli, Alessandro
title: Commentary-Aerosolization from chest drainage systems in patients with air leak: risk of viral spreading in the hospital and community
date: 2021-02-15
journal: Semin Thorac Cardiovasc Surg
DOI: 10.1053/j.semtcvs.2020.12.016
sha: 7b6e80d2dde5afe5f41a387e6e38cdd737dceddc
doc_id: 15376
cord_uid: ha4nf2wy

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Air leak from the lung may represent a potential source of viral spreading through the generation of aerosolised particles in the environment. Approximately 30-40% of patients have some degree of air leak immediately after surgery and 10-15% of all patients following lung resection will develop a prolonged air leak which will require them to carry a chest drain for a long time. In many centers patients with prolonged air leak are discharged home with a chest drain in place connected to a portable system. The ongoing COVID-19 pandemic has understandably raised awareness of the possible danger of exposing health care professionals and the community to aerosolised biologic fluids such as those produced in individuals with a chest drain and an active air leakage from their lungs. While in the hospital environment strict protective measures are now adopted by health care professionals performing aerosol Obviously, the results need to be interpreted taking into the account the limitations of the study, particularly the reproducibility of the lab model into the real-life patient care setting as aerosolization may depend by several external and variable factors which were not completely controlled in the laboratory. For this reason, it appears prudent to affirm that all current available chest drainage systems (not featuring an antiviral filter) may have the potential to generate aerosolised particles in the presence of an air leak.

The first critical phase when a patient with air leak could act as a spreader in the ward or community are during mobilisation and physiotherapy, which however is an essential part of the postoperative care of lung resection patients to enhance their recovery from surgery. In many units, it is standard practice for patients to walk around the ward immediately after their operation, carrying their chest drainage system along. This is generally supervised by multiple health care professionals such as nurses and physiotherapists and the patient can get in contact with other patients circulating in the ward. The study from Mustaev and coll (1) support the safety practice to organise this activity in a way to prevent the patient to wear a Unfortunately, there is no definitive solution which would apply to all settings and hopefully future research will lead to improved technology and safer drainage systems to overcome the current limitations unveiled by the ongoing pandemic.

Simulation and Measurement of Aerosolisation 1 in Different Chest Drainage Systems

The authors should be commended for conducting a very practical translational study which has the merit to inform the thoracic community and raise awareness on a very common problem in our practice.