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Efficacy of a surgical mask during high-flow nasal oxygen therapy in preventing aerosol dispersion: a randomized controlled study

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Abstract

Purpose

It is not clear whether or not high-flow nasal oxygenation used in patients with severe respiratory tract infection, or coughing, increases the risk of infection to the healthcare personnel, and whether or not applying a surgical mask to the patient’s face or treating the patient in a negative-pressure room can reduce the risk.

Methods

In a randomized crossover design, we compared in 50 participants receiving high-flow nasal oxygenation, the aerosol counts measured at approximately 20 cm above the participant’s mouth in 32 different circumstances (with or without coughing, with or without wearing a surgical mask, at four different flow rates of oxygenation, in a positive- or negative-pressure operating room).

Results

In a positive-pressure room, a surgical mask significantly decreased the aerosol counts during coughing (P = 0.0005), or during no coughing (P = 0.009), under high-flow nasal oxygenation (at 60 l.min−1). In the negative-pressure room, the aerosol count was significantly lower than in the positive-pressure room, for all the circumstances (all P < 0.001), and a surgical mask significantly decreased the aerosol counts during coughing (P = 0.047) but not during no coughing (P = 0.60).

Conclusion

In conclusion, treating a patient in a negative-pressure room, or applying a surgical mask, during high-flow nasal oxygenation (with the flow rate of 60 l.min−1) would inhibit, but would not completely prevent, dispersion of aerosols by coughing.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan

    Wakana Ugajin, Takashi Asai, Tomoyuki Saito & Yasuhisa Okuda

Authors
  1. Wakana Ugajin
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  2. Takashi Asai
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  3. Tomoyuki Saito
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  4. Yasuhisa Okuda
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Contributions

All the authors contributed to the study conception and design, material preparation, data collection and analysis. WU, TS and TA drafted the first manuscript, and all revising it critically for important intellectual content. All agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Wakana Ugajin.

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Conflict of interest

WU received Research incentive grant from Dokkyo Medical University. The other authors have no conflict of interests.

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Ugajin, W., Asai, T., Saito, T. et al. Efficacy of a surgical mask during high-flow nasal oxygen therapy in preventing aerosol dispersion: a randomized controlled study. J Anesth 37, 787–793 (2023). https://doi.org/10.1007/s00540-023-03237-w

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  • DOI: https://doi.org/10.1007/s00540-023-03237-w

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