key: cord-0951920-48wvdyo6
authors: Thibon, Christophe; Vecellio, Laurent; Jean-Christophe, D.U.B.U.S.; Kabamba, Benoît; Reychler, Gregory
title: Nebulization and COVID-19: Is the risk of spread actual?
date: 2022-04-20
journal: Respir Med
DOI: 10.1016/j.rmed.2022.106854
sha: 583210a0bff99d89b204c616b9e1e0622b318529
doc_id: 951920
cord_uid: 48wvdyo6

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The airborne transmission of SARS-CoV-2 has been quickly suggested based on the stability of SARS-CoV-2 in aerosol for 3 hours 1 . Nebulization, by a possible microorganisms contamination 2 and/or by the aerosolization of contaminated particles 3 , may theoretically expose mucosae and eyes of the health care workers to the virus and contaminate the surfaces with potentially infective droplets. Thus, various guidelines on nebulization emerged during the SARS-CoV-2 pandemic, in order to ensure a maximal protection (face masks for the patient, expiratory filter on the nebulizer, ventilation of the room, individual protection equipment for healthcare workers) 4 . To note, in the previous 2 years, clinicians do not report in daily practice viral clusters induced by nebulized treatments. This study aimed to address the risk of airborne transmission in patients hospitalized with severe COVID-19.

Ten severe COVID-19 patients (tachypnea, hypoxemia, more than 50% lung involved on imaging and treated with nebulization) were recruited at the admission in the hospital. They were treated by nebulization of isotonic saline solution (n=6), ipratropium bromide (n=2), or ipratropium and fenoterol (n=2) with a standard single-use jet nebulizer operating at 8 L/min with a T piece connected to a mouthpiece (Opti-Mist Plus®, ConvaTec, Bridgewater, NJ) and a filter. Immediately after the first nebulization, the residual solution of each nebulizer was sampled. Then, the nebulizers were refilled with 3 mL isotonic saline solution (0·9%) to complete the residual volume (1mL). The filter was replaced by a BioSampler® (SKC 20-mL) loaded with 20 mL phosphate-buffered saline (PBS) and 0·5% bovine serum albumin 5 The median viral load of the patients was 5·6x10 5 copies/mL (range 1·5x10 3 to 189x10 6 ). No SARS-CoV-2 RNA was found in any sample for all nebulizations.

The result of this study shows no SARS-CoV-2 nebulizers contamination by COVID-19 patients at hospital and does not support the role of nebulizers in terms of aerosol virus dissemination in air. Nevertheless, exhaled virus by the patient itself remains and must be considered independently to the nebulizer.

J o u r n a l P r e -p r o o f

No conflict of interest, Laurent.vecellio@univ-tours

MD, PhD, No conflict of interest

No conflict of interest

Group Aerosoltherapy GAT of the French Language Respiratory Society-Société de Pneumologie de Langue Française SPLF

Department of Microbiology

Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1

Bacterial Surface Detachment during Nebulization with Contaminated Reusable Home Nebulizers

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

Nebulization: A potential source of SARS-CoV-2 transmission

Live SARS-CoV-2 is difficult to detect in patient aerosols. Influenza Other Respir Viruses