title: Exhaled air dispersion during oxygen delivery via a simple oxygen mask.
abstract: BACKGROUND
  Pneumonia viruses such as influenza may potentially spread by airborne transmission. We studied the dispersion of exhaled air through a simple oxygen mask applied to a human patient simulator (HPS) during the delivery of different oxygen flow in a room free of air currents.
  
  
  METHODS
  The HPS represented a 70-kg adult male individual in a semi-sitting position on a hospital bed inclined at 45 degrees. A simple oxygen mask was fitted to the HPS in the normal fashion. The head, neck, and internal airways of the HPS were configured to allow realistic airflow modeling in the airways and around the face. The HPS was programmed to breathe at a respiratory rate of 14 breaths/min with a tidal volume of 0.5 L. Airflow was marked with intrapulmonary smoke for visualization. A leakage jet plume was revealed by a laser light-sheet, and images were captured by high-resolution video. Smoke concentration in the exhaled plume was estimated from the total light intensity scattered by smoke particles.
  
  
  RESULTS
  A jet plume of air leaked through the side vents of the simple oxygen mask to lateral distances of 0.2, 0.22, 0.3, and 0.4 m from the sagittal plane during the delivery of oxygen at 4, 6, 8, and 10 L/min, respectively. Coughing could extend the dispersion distance beyond 0.4 m.
  
  
  CONCLUSIONS
  Substantial exposure to exhaled air occurs generally within 0.4 m from patients receiving supplemental oxygen via a simple mask. Health-care workers should take precautions when managing patients with community-acquired pneumonia of unknown etiology that is complicated by respiratory failure.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong, People's Republic of China. dschui@cuhk.edu.hk
authors.forename: David S
authors.initials: DS
authors.lastname: Hui
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Hall
authors.forename: Matthew T V
authors.initials: MT
authors.lastname: Chan
authors.forename: Benny K
authors.initials: BK
authors.lastname: Chow
authors.forename: Susanna S
authors.initials: SS
authors.lastname: Ng
authors.forename: Tony
authors.initials: T
authors.lastname: Gin
authors.forename: Joseph J Y
authors.initials: JJ
authors.lastname: Sung
mesh_terms: D000328:Adult; D045853:Exhalation; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D008297:Male; D008397:Masks; D010102:Oxygen Inhalation Therapy / Q000295:instrumentation*; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D012141:Respiratory Tract Infections / Q000635:transmission*; D012307:Risk Factors; D014741:Video Recording