COVID-19 (CPAP)

  • NIV/CPAP  is an Aerosol Generating Proceedure (AGP)
    • Staff must wear full APG PPE
    • In Side room with a door
    • Door Marked with APG sign –HERE
  • CPAP/EPAP levels of 8-15cmH2O is suggested to work well by the Italian society of Emergency medicine
  • BTS has released the guidanceHERE 
    •  Masks 
      • 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

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