Passive Tracer Visualization to Simulate Aerodynamic Virus Transport in Noninvasive Respiratory Support Methods

Rutger Hebbink*, Judith Elshof, Steven Wanrooij, Walter Lette, Mariëtte Lokate, Cornelis Henricus Venner, Marieke Duiverman, Rob Hagmeijer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
33 Downloads (Pure)


Background: Various forms of noninvasive respiratory support methods are used in the treatment of hypoxemic CO­VID-19 patients, but limited data are available about the corresponding respiratory droplet dispersion. Objectives: The aim of this study was to estimate the potential spread of infectious diseases for a broad selection of oxygen and respiratory support methods by revealing the therapy-induced aerodynamics and respiratory droplet dispersion. Methods: The exhaled air-smoke plume from a 3D-printed upper airway geometry was visualized by recording light reflection during simulated spontaneous breathing, standard oxygen mask application, nasal high-flow therapy (NHFT), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The dispersion of 100 μm particles was estimated from the initial velocity of exhaled air and the theoretical terminal velocity. Results: Estimated droplet dispersion was 16 cm for unassisted breathing, 10 cm for Venturi masks, 13 cm for the nebulizer, and 14 cm for the nonrebreathing mask. Estimated droplet spread increased up to 34 cm in NHFT, 57 cm in BiPAP, and 69 cm in CPAP. A nonsurgical face mask over the NHFT interface reduced estimated droplet dispersion. Conclusions: During NHFT and CPAP/BiPAP with vented masks, extensive jets with relatively high jet velocities were observed, indicating increased droplet spread and an increased risk of droplet-driven virus transmission. For the Venturi masks, a nonrebreathing mask, and a nebulizer, estimated jet velocities are comparable to unassisted breathing. Aerosols are transported unboundedly in all these unfiltered therapies. The adequate use of protective measures is of vital importance when using noninvasive unfiltered therapies in infectious respiratory diseases.
Original languageEnglish
Pages (from-to)1196-1207
Number of pages12
JournalRespiration; international review of thoracic diseases
Issue number12
Early online date15 Sept 2021
Publication statusPublished - 1 Dec 2021


  • Droplet transmission of infectious disease
  • Respiratory care
  • Viral particles
  • SARS-CoV-2
  • COVID-19


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