Invasive ventilator exhaust in critical care: aerosol transmission risks and management strategies-a narrative review.

An Shi, Zhenyuan Yang, Ying Peng, Zhenjun Liu, Hanfeng Zhang

Abstract readReview

In one paragraph

Review in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it

0cells of the map it votes in

0citing papers in PubMed

–field-weighted citation impact

1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

An ShiSchool of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

Zhenyuan YangDepartment of Critical Care Medicine, Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital & Institute Sichuan Cancer Center University of Electronic Science and Technology of China, Chengdu, China.

Ying PengDepartment of Critical Care Medicine, Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital & Institute Sichuan Cancer Center University of Electronic Science and Technology of China, Chengdu, China.

Zhenjun LiuDepartment of Critical Care Medicine, Sichuan Clinical Research Center for Cancer Sichuan Cancer Hospital & Institute Sichuan Cancer Center University of Electronic Science and Technology of China, Chengdu, China. liuzhenjun@scszlyy.org.cn.

Hanfeng ZhangDepartment of Nursing, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center,University of Electronic Science and Technology of China, Chengdu, China. zhanghanfeng0727@163.com.

Funding

the Key Clinical Construction Project of Sichuan Province, China YB2022009

6 · The paper itself

Abstract

Invasive mechanical ventilation (IMV) is essential in intensive care, yet aerosols released with ventilator exhaust remain an under-recognized source of airborne transmission and occupational exposure. This review outlines how exhaust-borne aerosols are generated and dispersed in clinical workflows, with amplification during airway suctioning, therapeutic nebulization, and inhaled volatile sedation. We compare principal mitigation options-including heat-and-moisture exchanger (HME) devices and high-efficiency particulate air filtration (HEPA), directed discharge, and chemical inactivation-across effectiveness, operational complexity, adaptability, and strength of evidence. Building on a patient-device-environment framework, we propose a scenario-based, three-tier prevention strategy that aligns patient-side filtration, circuit and exhaust-end control, and ICU room-level airflow engineering with context-appropriate monitoring.Conclusion: Ventilator-exhaust management is feasible with current technologies, but standardized performance indicators and multicenter studies are needed to quantify reductions in cross-infection and occupational exposure and to inform harmonized technical standards and guidance.

Indexed as

Critical CareRespiration, ArtificialVentilators, MechanicalAerosolsHumansOccupational ExposureAerosolsAerosol transmissionHealthcare-associated infectionOccupational exposureVentilator exhaust gases

Identifiers

PMID41361786

DOI10.1186/s13054-025-05787-9

PMCPMC12690880

What OpenQuestion holds

Textmetadata

LicenceCC BY-NC-ND

Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.