The risk for cross-contamination associated to inhalational therapies, manipulations and interventions in the airways.
The COVID-19 virus is a droplet transmitted virus. Efforts should be taken to reduce any transmission of virus between individuals.
General recommendations are to keep distance of 1 to 2 meters. Keeping further distance when suspected individuals are sneezing and coughing.
To minimize risk for transmission and contamination in health care several additional precautions and recommendations has been issued.
General recommendations have also been provided to reduce the potential increased risk for transmission of COVID-19 virus associated to generation of aerosols from aerosol-generating procedures. WHO guidelines recommend1. The exact risk increase associated to aerosol and the aerosol formation potential associated with different inhalational interventions/therapies and airway interventions is not known. The paper by Tran et al2 is commonly referred to when risk associated to various inhalational therapies and airway interventions are discussed. This paper does provide odds ratios for common procedures, but did not find “significantly increased risks” associated to oxygen therapies. There have also been recommendations from National Societies that the use of nitrous oxide inhalation for the management of labor pain should not be used in mother with COVID-19 in order to minimize risk for aerosol formation and subsequent viral spread. While other national guidelines had not made any similar comments3.
It is of course of outmost importance to avoid any risk for contamination of healthcare personnel. There are today several reports of healthcare personnel being infected and with serious disease course and also fatal outcome.
It is important however to acknowledge that nitrous oxide per se do not increase risk for transmission. The risk increase would theoretically be the minor risk associated to an increased aerosol formation.
The risk for aerosol formation associated to the use of a demand valve and a nitrous oxide and oxygen mixture for inhalation during delivery is seemingly small.
Please note that we have issued this information based on our best knowledge. However, as information on COVID-19 is still fluid and subject to change we cannot assume any liability for this information.
Jan G Jakobsson
MD, PhD, Professor Anaesthesia & Intensive Care
Global Safety Physician Linde Healthcare
2 Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. PLoS One. 2012;7(4):e35797. doi: 10.1371/journal.pone.0035797. Epub 2012 Apr 26. Review.