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Original Research: RESPIRATORY INFECTION |

Exhaled Air and Aerosolized Droplet Dispersion During Application of a Jet Nebulizer

David S. Hui, MD, FCCP; Benny K. Chow, MPh; Leo C. Y. Chu, MBChB; Susanna S. Ng, MBChB; Stephen D. Hall, PhD; Tony Gin, MD; Matthew T. V. Chan, MD
Author and Funding Information

*From the Department of Medicine and Therapeutics (Drs. Hui and Ng), The Chinese University of Hong Kong; Center for Housing Innovations (Mr. Chow), Institute of Space and Earth Information Science, The Chinese University of Hong Kong; Department of Anesthesia and Intensive Care (Drs. Chu, Chan, and Gin), The Chinese University of Hong Kong; and School of Mechanical Engineering (Dr. Hall), The University of New South Wales, Australia.

Correspondence to: David S. Hui, MD, FCCP, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30–32 Ngan Shing St, Shatin, NT, Hong Kong; e-mail: dschui@cuhk.edu.hk


Funding was provided by the Research Fund for the Control of Infectious Diseases No. 06060202 (Food and Health Bureau, Hong Kong Special Administrative Region).

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(3):648-654. doi:10.1378/chest.08-1998
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Background:  As part of our influenza pandemic preparedness, we studied the dispersion distances of exhaled air and aerosolized droplets during application of a jet nebulizer to a human patient simulator (HPS) programmed at normal lung condition and different severities of lung injury.

Methods:  The experiments were conducted in a hospital isolation room with a pressure of − 5 Pa. Airflow was marked with intrapulmonary smoke. The jet nebulizer was driven by air at a constant flow rate of 6 L/min, with the mask reservoir filled with sterile water and attached to the HPS via a nebulizer mask. The exhaled leakage jet plume was revealed by a laser light sheet and images captured by high-definition video. Smoke concentration in the plume was estimated from the light scattered by smoke and droplet particles.

Findings:  The maximum dispersion distance of smoke particles through the nebulizer side vent was 0.45 m lateral to the HPS at normal lung condition (oxygen consumption, 200 mL/min; lung compliance, 70 mL/cm H2O), but it increased to 0.54 m in mild lung injury (oxygen consumption, 300 mL/min; lung compliance, 35 mL/cm H2O), and beyond 0.8 m in severe lung injury (oxygen consumption, 500 mL/min; lung compliance, 10 mL/cm H2O). More extensive leakage through the side vents of the nebulizer mask was noted with more severe lung injury.

Interpretation:  Health-care workers should take extra protective precaution within at least 0.8 m from patients with febrile respiratory illness of unknown etiology receiving treatment via a jet nebulizer even in an isolation room with negative pressure.

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