Aerosolization during intubation and extubation and its associated risk of transmission of SARS-CoV-2 to healthcare workers: a scoping review.

Abstract

Background: Healthcare workers, in particular anesthesiologists, are at risk for many infectious diseases that could potentially be transmitted during intubations and extubations. Although intubation and extubation are known to stimulate coughing and to promote the generation of aerosols, their risk of transmission of COVID-19 infection is still not clearly understood. Among the aerosol generating procedures, intubation and extubation is thought to be especially harmful due to the proximity of the anaesthetist to the patient’s airway. The aim this study is to explore and describe the risk of aerosolisation of SARS-CoV-2 to the anaesthetist during airway management. Methods: We conducted a scoping review of PubMed, MEDLINE, LANCET, and grey literature related to intubations and extubations, and the risk of transmission of infections to the anaesthetist. The scoping review was conducted using the Arksey and O’ Malley framework for scoping reviews. We conducted a narrative synthesis of the evidence gathered. There were no restrictions on study design, year of publication, and study location. The literature search was updated on the 15th of July 2023. Results: Our scoping review showed that healthcare workers involved in airway procedures specifically intubation and extubation are at an increased risk of contracting SARS-COV-1 and SARS-COV-2. Aerosol generation during these procedures has been shown to generate less aerosol than that of a cough. Extubations are particularly riskier regarding aerosol exposure than intubations. The relationship between aerosol exposure and virus transmission is uncertain. Conclusions: Anaesthetists are at increased risk of infection during intubations and extubations. There remains a lack of evidence of the exact mechanisms of transmission from patients to healthcare workers during aerosol-generating procedures. There is also a lack of consistency in the definition of aerosol-generating procedures.