- Any use of non-invasive ventilation (NIV = CPAP or BiPAP) or high flow nasal cannula (HFNC) is considered an aerosol-generating medical procedure (AGMP).
- Every use of NIV or HFNC (including home NIV) requires the following mandatory precautions:
- All patients must receive a nasopharyngeal swab (NPS) for COVID-19 regardless of symptoms at initiation.
- Use must only be in a negative pressure room or a private room with a closed door and a HEPA-filter. The patient will not be transported on these therapies.
- AGMP (Airbourne/contact/droplet) precautions must be undertaken for all staff entering the room.
- If HFNC is in use, the patient should wear a surgical mask if possible.
- NIV is currently not permitted for use in any patients with suspected or confirmed COVID.
- NIV may be used for evidence-based indications for a brief period of time in the ED (typically 4-6 hours) which include only (please review flow-chart below):
- Cardiogenic pulmonary edema without suspicion of infection
- Critically ill asthmatic not requiring immediate intubation
- Non-infectious exacerbation of chronic obstructive pulmonary disease (COPD).
- If the patient cannot be liberated from NIV following initial therapy (4-6 hours), critical care consultation is indicated.
- If the patient is a candidate for intubation (i.e. it is on offer), high-flow nasal cannula (HFNC) may be used for COVID pneumonia if ordered by a critical care physician.
- For many patients on home CPAP or BiPAP, therapy can be suspended for 3-4 days without harm. If the hospital stay is longer or there are questions, we recommend a respirology consultation and a COVID swab be performed.
Non-invasive Ventilation & High-Flow Nasal Cannula
Last Updated on: April 15th, 2020 at 1:35 am