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Abstract：
BACKGROUND: The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern.
OBJECTIVE: To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing.
METHODS: The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice.
RESULTS: Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions.
CONCLUSIONS: There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.
OBJECTIVE: To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing.
METHODS: The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice.
RESULTS: Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions.
CONCLUSIONS: There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.
摘要：
背景：由医疗程序产生的气溶胶传播SARS-CoV-2的风险令人担忧。
目的：评估与气道抽吸或诱发咳嗽/打喷嚏相关的气雾剂产生和呼吸道感染传播的证据。
方法：本综述由PRISMA指南提供。在PubMed中对1月1日之间发表的研究进行了搜索，2003年10月6日,2020年。纳入的研究检查了是否插入鼻胃管，肺功能检查,鼻内窥镜检查,吞咽困难评估,或吸入气道清除导致SARS-CoV-2，SARS-CoV，MERS,或流感。偏差风险评估侧重于测量的稳健性，控制混杂，和临床实践的适用性。
结果：共纳入18项主要研究和2项系统综述。三项流行病学研究发现，鼻胃管插入与呼吸道感染之间没有关联。一项模拟研究发现，与肺肺功能测试相关的气溶胶产量低/非常低。对内窥镜鼻窦手术的七项模拟研究表明，气溶胶显着增加，但结果不一致；两项临床研究发现，空气中的颗粒与微清创器/钻头的使用有关。一些模拟研究没有使用强大的措施来检测颗粒，并且很难等同于临床条件。
结论：没有证据表明审查中包括的手术与呼吸道感染传播风险增加相关。为了更好地制定预防措施以降低风险，需要更多的研究来确定增加SARS-CoV-2传播风险的医疗程序和患者的特征。
目的：评估与气道抽吸或诱发咳嗽/打喷嚏相关的气雾剂产生和呼吸道感染传播的证据。
方法：本综述由PRISMA指南提供。在PubMed中对1月1日之间发表的研究进行了搜索，2003年10月6日,2020年。纳入的研究检查了是否插入鼻胃管，肺功能检查,鼻内窥镜检查,吞咽困难评估,或吸入气道清除导致SARS-CoV-2，SARS-CoV，MERS,或流感。偏差风险评估侧重于测量的稳健性，控制混杂，和临床实践的适用性。
结果：共纳入18项主要研究和2项系统综述。三项流行病学研究发现，鼻胃管插入与呼吸道感染之间没有关联。一项模拟研究发现，与肺肺功能测试相关的气溶胶产量低/非常低。对内窥镜鼻窦手术的七项模拟研究表明，气溶胶显着增加，但结果不一致；两项临床研究发现，空气中的颗粒与微清创器/钻头的使用有关。一些模拟研究没有使用强大的措施来检测颗粒，并且很难等同于临床条件。
结论：没有证据表明审查中包括的手术与呼吸道感染传播风险增加相关。为了更好地制定预防措施以降低风险，需要更多的研究来确定增加SARS-CoV-2传播风险的医疗程序和患者的特征。
