A quantitative evaluation of aerosol generation during manual facemask ventilation

SummaryManual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol generating procedure. This designation is based on a single epidemiological study suggesting an association between facemask ventilation and transmission from the SARS 2003 outbreak. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation, and facemask ventilation with an intentionally generated leak, in anaesthetised patients with neuromuscular blockade. Recordings were made in ultraclean theatres and compared against the aerosol generated by the patient’s own tidal breathing and coughs. Respiratory aerosol from tidal breathing was reliably detected above the very low background particle concentrations (191 (77-486 [3.8-1313]) versus 2.1 (0.7-4.6 [0-12.9] particles.l-1 median(IQR)[range], n=11, p=0.002). The average aerosol concentration detected during facemask ventilation both without a leak (3.0 particles.l-1 (0 – 9 [0-43])) and with an intentional leak (11 particles.l-1 (7.0 – 26 [1-62])) was 64-fold and 17-fold lower than that of tidal breathing (p=0.001 and p=0.002 respectively). The peak particle concentration during facemask ventilation both without a leak (60 particles.l-1 (0 – 60 [0-120])) and with a leak (120 particles.l-1 (60 – 180 [60-480]) were respectively 20-fold and 10-fold lower than a cough (1260 particles (800 – 3242 [100-3682]), p=0.002 and p=0.001 respectively). This study demonstrates that facemask ventilation, even performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, facemask ventilation should not be considered an aerosol generating procedure.

The important roles of surface tension and growth rate in the contribution of new particle formation (NPF) to cloud condensation nuclei (CCN) number concentration: evidence from field measurements in southern China

The contribution of new particle formation (NPF) to cloud condensation nuclei (CCN) number concentration (NCCN) varies largely under different environments and depends on several key factors such as formation rate (J), growth rate (GR), distribution of preexisting particles, and properties of new particles during NPF events. This study investigates the contribution of NPF to the NCCN and its controlling factors based on measurements conducted at the Heshan supersite, in the Pearl River Delta (PRD) region of China during fall 2019. The size-resolved cloud condensation nuclei activity and size-resolved particle hygroscopicity were measured by a cloud condensation nuclei counter (CCNc) and a hygroscopic tandem differential mobility analyzer (HTDMA), respectively, along with a scanning mobility particle sizer (SMPS) and a diethylene glycol scanning mobility particle sizer (DEG-SMPS) for particle number size distribution (PNSD). A typical NPF event on 29 October was chosen to investigate the contribution of the NPF to NCCN under several supersaturation (SS) ratios. Two particle properties (hygroscopicity and surface tension) affect CCN activation with the latter being more important in terms of the CCN concentration (NCCN). A lower value of surface tension (i.e., 0.06 N m−1) than the pure-water assumption (0.073 N m−1) could increase the NCCN at SS = 1.0 % by about 20 % during the nonevent period and by about 40 % during the event. In addition, an earlier peak time corresponding to a lower critical diameter (D50) was also observed. The results show that high formation rate, growth rate, and low background particle concentration lead to high number concentrations of newly formed particles. The high growth rate was found to have the most significant impact on the NCCN, which can be attributed to the fact that a higher growth rate can grow particles to the CCN size in a shorter time before they are scavenged by preexisting particles. Two other NPF events (an event on 18 October in this campaign and an event on 12 December 2014 in Panyu) were chosen to perform sensitivity tests under different scenarios (growth rate, formation rate, and background particle concentration). The calculated NCCN at SS = 1.0 % on 12 December 2014 was significantly lower than that from the other two events. The event on 12 December was re-simulated using the growth rate taken from the event on 18 October which resulted in similar CCN concentrations between the two events (12 December and 18 October), implying that the growth rate is the major impact factor for CCN activation. Our results highlight the importance of growth rate and surface tension when evaluating the contribution of NPF to the NCCN.

Postfrontal nanoparticles at Cape Grim: impact on cloud nuclei concentrations

Environmental context. Accurate prediction of climate change requires good knowledge of all the contributing processes; those processes controlling clouds and cloud properties are of particular importance. In this study the growth of bursts of nanometre-sized particles observed following cold fronts over the Southern Ocean was modelled to assess their importance as a source of cloud droplet nuclei. This showed that these post-frontal events were responsible for ~8% of the cloud nucleus population in winter but much less in summer. Abstract. Aerosol removal and growth rates were determined for the Cape Grim marine boundary layer (MBL) using local observations. Background particle growth rates, estimated using replacement of condensable sulfur species lost to particle removal are 0.04 nm h–1 (winter) and 0.17 nm h–1 (summer) and for post-frontal nucleation-events growth rates determined using evolution of the concentration ratio of particles with diameter >3 nm and 11 nm are ~0.3–0.4 nm h–1, consistent with reported high-latitude events. A box model using region-specific loss and growth rates predicts free-troposphere/MBL N3 ratios of 1.3–2.1 and 2.4–2.5 for background and event growth rates, compared with observations in the range of 0.7–1.5. Post-frontal nucleation events were found to contribute from <1 to ~8% of the CCN population depending on season and growth rate. However, these events help maintain the MBL Aitken population, contributing up to ~30%.