Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections

Simonds, AK; Hanak, A.; Chatwin, Michelle; Morrell, MJ; Hall, Aron J.; Parker, KH; Siggers, J.H.; Dickinson, RJ

doi:10.3310/hta14460-02

Cited by 226 publications

(216 citation statements)

References 9 publications

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“…Based on the Toronto experience with SARS, 76 in which some clinicians contracted SARS during intubation of patients who failed NIV, the use of NIV was discouraged because of infection risk, but this was recently challenged by Simonds et al, 77 who found that the droplets generated during NIV are Ͼ 10 m, so that they are not likely to remain airborne.…”

Section: Risky Business Pandemic Diseasesmentioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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It is difficult to exactly date the beginning of mechanical ventilation, but there are no doubts that noninvasive ventilation (NIV) was the first method of ventilatory support in clinical practice. The technique had a sudden increase in popularity, so that it is now considered, according to criteria of evidence-based medicine, the first-line treatment for an episode of acute respiratory failure in 4 pathologies (the Fabulous Four): COPD exacerbation, cardiogenic pulmonary edema, pulmonary infiltrates in immunocompromised patients, and in the weaning of extubated COPD patients. The so-called emerging applications are those for which the evidence has not achieved level A, mainly because the number or sample size of the published studies does not allow conclusive meta-analysis. These emerging applications are the post-surgical period, palliation of dyspnea, asthma attack, obesity hypoventilation syndrome, and to prevent extubation failure. Potentially "risky business" uses include for respiratory failure from pandemic diseases and ARDS, where probably the "secret" for success is early use. Healthcare is rich in evidence-based innovations, yet even when such innovations are implemented successfully in one location, they often disseminate slowly, if at all, so their clinical use remains limited and heterogeneous. The low rate of NIV use in some hospitals relates to lack of knowledge about or experience with NIV, insufficient confidence in the technique, lack of NIV equipment, and inadequate funding. But NIV use has been increasing around the world, thanks partly to improved technologies. The skill and confidence of clinicians in NIV have improved with time and experience, but NIV is and should remain a team effort, rather than the property of a single local "champion," because, overall, NIV is beautiful!

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Section: Risky Business Pandemic Diseasesmentioning

confidence: 99%

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Nava

2013

Respir Care

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“…Another study showed that NIV and chest physiotherapy are dropletgenerating procedures, producing droplets of .10 mm in size. Due to their large mass, most fall out on to local surfaces within 1 m. These findings confirm that healthcare workers providing NIV and chest physiotherapy, and working within 1 m of an infected patient should have a higher level of respiratory protection, but that infection control measures designed to limit aerosol spread may have less relevance for these procedures [86]. The World Health Organization (WHO) has included NIV among aerosol-generating procedures in which the risk of pathogen transmission is possible [87].…”

Section: Pandemicsmentioning

confidence: 63%

Unusual applications of noninvasive ventilation

Ambrosino¹,

Guarracino²

2011

Eur Respir J

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The use of noninvasive ventilation (NIV) in acute hypercapnic respiratory failure, cardiogenic pulmonary oedema, acute lung injury/acute respiratory distress syndrome (ARDS), community-acquired pneumonia and weaning/post-extubation failure is considered common in clinical practice. Herein, we review the use of NIV in unusual conditions.Evidence supports the use of NIV during fibreoptic bronchoscopy, especially with high risks of endotracheal intubation (ETI), such as in immunocompromised patients. During transoesophageal echocardiography as well as in interventional cardiology and pulmonology, NIV can reduce the need for deep sedation or general anaesthesia and prevent respiratory depression induced by deep sedation. NIV may be useful after surgery, including cardiac surgery, and, with a lower level of evidence, in patients with pulmonary contusion.NIV should not be considered as an alternative to ETI in severe communicable airborne infections likely to progress to ARDS. NIV is being used increasingly as an alternative to ETI in end-stage symptomatic patients, especially to relieve dyspnoea. The role of assisted ventilation during exercise training in chronic obstructive pulmonary disease patients is still controversial.NIV should be applied under close monitoring and ETI should be promptly available in the case of failure. A trained team, careful patient selection and optimal choice of devices, can optimise outcome of NIV.

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“…The amount of droplets falls significantly at a distance .1 m from the patient [39,40], but healthcare workers who apply NIV have to stand close to the patient and, therefore, can be exposed to potentially infectious droplets. The decision whether or not NIV can be used in these situations, as well as the general precautions to reduce disease transmission, usually depends on local infection policies.…”

Section: Droplet Generation and Airborne Diseasementioning

confidence: 99%

“…The decision whether or not NIV can be used in these situations, as well as the general precautions to reduce disease transmission, usually depends on local infection policies. However, if NIV is applied, a nonvented facial mask and filtered exhalate can reduce environmental spread [39]. Also, fitting and securing the mask before the ventilator is turned on and similarly turning off the ventilator before the mask is removed or lifted away from the face is usually recommended.…”

Section: Droplet Generation and Airborne Diseasementioning

confidence: 99%

How to avoid interface problems in acute noninvasive ventilation

Brill¹

2014

Breathe

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SummaryNoninvasive ventilation (NIV) appliedviadifferent interfaces is increasingly used in the treatment of acute respiratory failure. One of the key factors determining the success of NIV is the choice of interface. Interface selection, fitting and handling can be challenging as NIV application can be complicated by discomfort, air leaks, skin damage or conjunctivitis. The aim of this article is to provide practical information on interface choice, technical aspects of mask fitting and prevention of mask-related problems during the acute delivery of NIV.Educational aimsTo help the reader to recognise the different features of interfaces and to discuss common interface-related problemsTo provide practical recommendations to facilitate the choice and application of interfaces in order to reduce complications

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Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections

Cited by 226 publications

References 9 publications

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Behind a Mask: Tricks, Pitfalls, and Prejudices for Noninvasive Ventilation

Unusual applications of noninvasive ventilation

How to avoid interface problems in acute noninvasive ventilation

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