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Minimizing the Risk of Aerosol Contamination During Elective Lung Resection Surgery.
Rakovich, George; Urbanowicz, Robert; Issa, Rami; Wang, Han Ting.
  • Rakovich G; Section for Thoracic Surgery, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
  • Urbanowicz R; Department of Anesthesiology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
  • Issa R; Department of Anesthesiology, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
  • Wang HT; Department of Medicine, Division of Critical Care, University of Montreal, Maisonneuve-Rosemont Hospital, Montreal, Canada.
Ann Surg ; 272(2): e125-e128, 2020 08.
Article in English | MEDLINE | ID: covidwho-706789
ABSTRACT

BACKGROUND:

In the setting of the COVID-19 pandemic, the conduct of elective cancer surgery has become an issue because of the need to balance the requirement to treat patients with the possibility of transmission of the virus by asymptomatic carriers. A particular concern is the potential for viral transmission by way of aerosol which may be generated during perioperative care. There are currently no guidelines for the conduct of elective lung resection surgery in this context.

METHODS:

A working group composed of 1 thoracic surgeon, 2 anesthesiologists and 1 critical care specialist assessed the risk for aerosol during lung resection surgery and proposed steps for mitigation. After external review, a final draft was approved by the Committee for the Governance of Perioperative and Surgical Activities of the Hôpital Maisonneuve-Rosemont, in Montreal, Canada.

RESULTS:

The working group divided the risk for aerosol into 6 time-points (1) intubation and extubation; (2) Lung isolation and patient positioning; (3) access to the chest; (4) conduct of the surgical procedure; (5) procedure termination and lung re-expansion; (6) chest drainage. Mitigating strategies were proposed for each time-point.

CONCLUSIONS:

The situation with COVID-19 is an opportunity to re-evaluate operating room protocols both for the purposes of this pandemic and similar situations in the future. In the context of lung resection surgery, specific time points during the procedure seem to pose specific risks for the genesis of aerosol and thus should be the focus of attention.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Operating Rooms / Pneumonia, Viral / Pulmonary Surgical Procedures / Equipment Contamination / Infection Control / Coronavirus Infections / Aerosols / Lung Neoplasms Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: Ann Surg Year: 2020 Document Type: Article Affiliation country: SLA.0000000000004087

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Operating Rooms / Pneumonia, Viral / Pulmonary Surgical Procedures / Equipment Contamination / Infection Control / Coronavirus Infections / Aerosols / Lung Neoplasms Type of study: Experimental Studies / Observational study / Prognostic study Limits: Humans Country/Region as subject: North America Language: English Journal: Ann Surg Year: 2020 Document Type: Article Affiliation country: SLA.0000000000004087