Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

Gómez, César Cinesi; Rodríguez, Óscar Peñuelas; Luján, Manel; Santaolalla, Carlos Egea; Jiménez, J.F. Masa; Fernández, Javier García; Perales, José Manuel Carratalá; Heili-Frades, Sarah Béatrice; Monreal, Miquel Ferrer; Nilsson, J.M. de Andrés; Arias, Eva Lista; Rocamora, Juan Luis Sánchez; Garrote, José Ignacio; Serrano, Miguel J. Zamorano; Martínez, Mónica González; Muñoz, Eva Farrero; Andrés, Olga Mediano San; Cervera, G. Rialp; Serra, Arantxa Mas; Martínez, GA; López, C. de Haro; Gas, Oriol Roca; Ferrer, Ricard; Berrocal, Antonio Romero; Ortolá, C. Ferrando

doi:10.1016/j.medine.2020.03.002

Cited by 20 publications

(26 citation statements)

References 37 publications

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“…This is further supported by the literature, as discussed above, when one considers the requirement to break the ventilator circuit for pMDI drug administration. Conversely, this study supports the various clinical guidance documents that call for closed-circuit aerosol delivery systems in an effort to minimise the risk of escape of patient-derived bioaerosols [45][46][47]. This current research will increase the understanding of aerosol drug delivery across different drug delivery devices during standard and LTV ventilation utilising active and passive humidification.…”

Section: Discussionsupporting

confidence: 76%

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

et al. 2021

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Drug delivery devices used for aerosol therapy during mechanical ventilation to ease the symptoms of respiratory diseases provide beneficial treatment but can also pose challenges. Reflecting the significant changes in global guidance around aerosol usage and lung-protective ventilation strategies, seen in response to the COVID-19 pandemic, for the first time, we describe the drug delivery performance of commonly used devices under these conditions. Here, vibrating mesh nebuliser (VMN), jet nebuliser (JN) and pressurised metered-dose inhaler (pMDI) performance was assessed during simulated adult mechanical ventilation. Both standard test breathing patterns and those representatives of low tidal volume (LTV) ventilation with concurrent active and passive humidification were investigated. Drug delivery using a VMN was significantly greater than that with a JN and pMDI for both standard and LTV ventilation. Humidification type did not affect the delivered dose across all device types for standard ventilation. Significant variability in the pMDI dosing was evident, depending on the timing of actuation and the adapter type used. pMDI actuation synchronised with inspiration resulted in a higher delivered drug dose. The type of adapter used for pMDI actuation influenced drug delivery, with the highest dose observed using the CombiHaler.

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Section: Discussionsupporting

confidence: 76%

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

et al. 2021

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“…While some guidelines suggest that nebuliser treatments are considered AGPs [12,13], there is insufficient evidence as to whether nebulisers are associated with the transmission of COVID-19 [14]. Nevertheless, guidance is provided that states that in the critically ill COVID-19 patient in receipt of ventilatory support, aerosol therapy may be used, but only with nebulisers that do not require the circuit to be broken or opened, for example, mesh nebulisers [7,[15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

Nebuliser Type Influences Both Patient-Derived Bioaerosol Emissions and Ventilation Parameters during Mechanical Ventilation

et al. 2021

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COVID-19 may lead to serious respiratory complications which may necessitate ventilatory support. There is concern surrounding potential release of patient-derived bioaerosol during nebuliser drug refill, which could impact the health of caregivers. Consequently, mesh nebulisers have been recommended by various clinical practice guidelines. Currently, there is a lack of empirical data describing the potential for release of patient-derived bioaerosol during drug refill. This study examined the release of simulated patient-derived bioaerosol, and the effect on positive end expiratory pressure during nebuliser refill during mechanical ventilation of a simulated patient. During jet nebuliser refill, the positive end expiratory pressure decreased from 4.5 to 0 cm H2O. No loss in pressure was noted during vibrating mesh nebuliser refill. A median particle number concentration of 710 particles cm−3 above ambient was detected when refilling the jet nebuliser in comparison to no increase above ambient detected when using the vibrating mesh nebuliser. The jet nebuliser with the endotracheal tube clamped resulted in 60 particles cm−3 above ambient levels. This study confirms that choice of nebuliser impacts both the potential for patient-derived bioaerosol release and the ability to maintain ventilator circuit pressures and validates the recommended use of mesh nebulisers during mechanical ventilation.

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Section: Discussionmentioning

confidence: 99%

“…The first-choice treatment for ARDS is mechanical ventilation (MV) with the use of orotracheal intubation (OTI) [ [14] , [15] , [16] , 21 ]. In the clinical event of resource and device shortage (full ICU, respirator shortage and lack of healthcare professionals), noninvasive respiratory support can be considered a valid alternative despite the worsening prognosis already published [ 11 , 21 , 25 ]. Both NIMV and CPAP or high‑oxygen airflow therapy can be administered to patients by several devices depending on the availability and indication: oronasal masks, facial masks or helmets [ [26] , [27] , [28] ].…”

Section: Discussionmentioning

confidence: 99%

“…This is why current lines of work are focused on developing respiratory support alternatives that will gain time or allow the maintenance of an acceptable respiratory status until patients can access the ICU [ 19 , 20 ]. In the absence of approved mechanical devices, such as continuous positive airway pressure (CPAP), positive end-expiratory pressure (PEEP) devices are being used [ 14 , 16 , 21 ]. In this paper, we describe our experience with the adaptation of diving masks ( Fig.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic

Bibiano-Guillén¹,

Arias-Arcos²,

Collado-Escudero³

et al. 2021

The American Journal of Emergency Medicine

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Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

Cited by 20 publications

References 37 publications

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

Evaluation of Aerosol Drug Delivery Options during Adult Mechanical Ventilation in the COVID-19 Era

Nebuliser Type Influences Both Patient-Derived Bioaerosol Emissions and Ventilation Parameters during Mechanical Ventilation

Adapted Diving Mask (ADM) device as respiratory support with oxygen output during COVID-19 pandemic

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