Well-fitting oronasal facemasks, masks over the total face, or helmets should produce least droplet dissemination.
Vented masks could worsen contamination of the environment
Any patient on acute NIV should be managed with a non-vented mask and an exhalation port in the circuit.
Ensure that the ventilator mode employed supports the use of non-vented masks and exhalation ports.
Sequence of actions: NIV mask on >ventilator on; ventilator off > NIV mask off.
Filters
A viral/bacterial filter should be placed in the circuit between the mask and the exhalation port (Figure below).
This viral/bacterial filter can replace any filter at the machine end of the circuit.
Viral/bacterial filters should ideally be changed every 24 hours or sooner. (There is a risk that they will become wet due to exhaled gas and that this may increase resistance to flow.)
An external humidifier must not be used.
Blocked filters can be mistaken for clinical deterioration; this issue is remedied by changing filters.
Oxygen – entrained at patients end (on mask
Review
Review at 2 hours
Stable – continue CPAP/NIV
Deteriorating – the patient will likely die with ought intubation, escalate or palliate.
Destinations
Failing on NIV/CPAP – Consider either escalation to intubation OR palliation
Maintaining Oxygenation – At CRH negative pressure room, at HRI side room acute floor
