Reducing aerosol dispersion by high flow therapy in COVID‐19: High resolution computational fluid dynamics simulations of particle behavior during high velocity nasal insufflation with a simple surgical mask

• Published in: Journal of the American College of Emergency Physicians Open Vol. 1; no. 4; pp. 578 - 591
• Main Authors: Leonard, Scott, Strasser, Wayne, Whittle, Jessica S., Volakis, Leonithas I., DeBellis, Ronald J., Prichard, Reid, Atwood, Charles W., Dungan, George C.
• Format: Journal Article Web Resource
• Language: English
• Published: United States John Wiley & Sons, Inc 01.08.2020; John Wiley and Sons Inc; Wiley
• Subjects: aerosol‐generating procedures; exhalation; high flow nasal cannula; high flow oxygen; high velocity nasal insufflation; Infectious Disease; low flow oxygen; masks; Original Research; particle dispersion/transmission; patient simulation; prevention/control; HFNC; High Flow Oxygen; Patient Simulation; Particle Dispersion/Transmission; Prevention/Control; Low Flow Oxygen; Aerosol Generating Procedures; Exhalation; HVNI; Masks
• ISSN: 2688-1152; 2688-1152
• DOI: 10.1002/emp2.12158

Objective All respiratory care represents some risk of becoming an aerosol‐generating procedure (AGP) during COVID‐19 patient management. Personal protective equipment (PPE) and environmental control/engineering is advised. High velocity nasal insufflation (HVNI) and high flow nasal cannula (HFNC) deliver high flow oxygen (HFO) therapy, established as a competent means of supporting oxygenation for acute respiratory distress patients, including that precipitated by COVID‐19. Although unlikely to present a disproportionate particle dispersal risk, AGP from HFO continues to be a concern. Previously, we published a preliminary model. Here, we present a subsequent highresolution simulation (higher complexity/reliability) to provide a more accurate and precise particle characterization on the effect of surgical masks on patients during HVNI, low‐flow oxygen therapy (LFO2), and tidal breathing. Methods This in silico modeling study of HVNI, LFO2, and tidal breathing presents ANSYS fluent computational fluid dynamics simulations that evaluate the effect of Type I surgical mask use over patient face on particle/droplet behavior. Results This in silico modeling simulation study of HVNI (40 L min−1) with a simulated surgical mask suggests 88.8% capture of exhaled particulate mass in the mask, compared to 77.4% in LFO2 (6 L min−1) capture, with particle distribution escaping to the room (> 1 m from face) lower for HVNI+Mask versus LFO2+Mask (8.23% vs 17.2%). The overwhelming proportion of particulate escape was associated with mask‐fit designed model gaps. Particle dispersion was associated with lower velocity. Conclusions These simulations suggest employing a surgical mask over the HVNI interface may be useful in reduction of particulate mass distribution associated with AGPs.