Special Issue on COVID-19 Aerosol Drivers, Impacts and Mitigation (VIII)

Ciarraí O’Toole This email address is being protected from spambots. You need JavaScript enabled to view it.1, James A. McGrath1, Mary Joyce2, Gavin Bennett2, Miriam A. Byrne1, Ronan MacLoughlin2,3,4

1 School of Physics & Ryan Institute’s Centre for Climate and Air Pollution Studies, National University of Ireland Galway H91 CF50, Galway, Ireland
2 Aerogen, IDA Business Park, Dangan, H91 HE94, Galway, Ireland
3 School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, D02 YN77, Dublin, Ireland
4 School of Pharmacy and Pharmaceutical Sciences, Trinity College, D02 PN40, Dublin, Ireland

Received: April 27, 2020
Revised: September 3, 2020
Accepted: October 3, 2020

 Copyright The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are cited.

Download Citation: ||https://doi.org/10.4209/aaqr.2020.04.0176  

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Cite this article:

O’Toole, C., McGrath, J.A., Joyce, M., Bennett, G., Byrne, M.A. and MacLoughlin, R. (2020). Fugitive Aerosol Therapy Emissions during Mechanical Ventilation: In Vitro Assessment of the Effect of Tidal Volume and Use of Protective Filters. Aerosol Air Qual. Res. 20: 2604–2613. https://doi.org/10.4209/aaqr.2020.04.0176


  • Greater quantities of fugitive emissions are seen at higher tidal volumes.
  • Applying a filter at the exhalation port of the mechanical ventilator reduced emissions.
  • MMAD decreased during nebulisation for the no filter scenario compared to pre-nebulisation.


Background: During mechanical ventilation of a patient requiring ventilatory support, bystanders could potentially be exposed to aerosolised drug. Methods: Fugitive drug aerosol emissions during simulated adult mechanical ventilation was assessed on a dual limb circuit. Tidal volume was set at 270 mL and 820 mL. The use of a protective filter on the exhalation port of the mechanical ventilator was assessed. Results: Higher fugitive aerosol mass concentrations in the local environment were associated with larger tidal volume (0.077 (0.073, 0.091) mg m–3 at Vt = 820 mL vs. 0.062 (0.056, 0.065) mg m–3 at Vt = 270 mL) when no protective filter was used. The range of mass median aerodynamic diameters recorded was from 0.93 to 2.96 µm. When a filter was placed on the exhalation port of the mechanical ventilator, no fugitive emissions were recorded. Conclusion: This study confirms that an appropriate filtration protocol mitigates the risk of fugitive emissions being released when patients undergo aerosol therapy during mechanical ventilation. A larger tidal volume resulted in higher fugitive aerosol mass.

Keywords: Aerosols; Protective filters; Exposure; Fugitive; Exhaled air.

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