Tables
- Table 1. Published data on noninvasive ventilation (NIV) during severe acute respiratory syndrome (SARS) infections
First author [ref.] Year Country Study design Interface Received NIV NIV failure Transmission among HCW# Mortality Observations Lin [11] 2003 China Retrospective, single centre Face mask n=40 (51.9%) n=8 (10.3%) No 9% 70 (90.9%) patients were clinically cured Cheung [12] 2004 China Case series, single centre (n=31) Face mask n=20 n=14 (70%) No 0% Fowler [13] 2004 Canada Retrospective, single centre Face mask 0 n=38 No 50% after NIV failure Affected patients had primarily single organ respiratory failure Sung [14] 2004 China Prospective, single centre (n=37) Face mask n=15 n=21 (15.2%) No n=15 (10.9%) Most patients had significant comorbidities Yam [8] 2005 China Retrospective, single centre Face mask n=21 n=8 (38%) No n=9 (35%) Early application of NIV as initial support for SARS-related ARF appeared to be associated with significantly reduced need for ETI and mortality HCW: healthcare workers; ARF: acute respiratory failure; ETI: endotracheal intubation. #: instances of transmission of SARS among HCW.
- Table 2. Published data on noninvasive ventilation (NIV) during pandemic influenza A H1N1
First author [ref.] Year Country Study design Interface Received NIV NIV failure Transmission among HCW# Mortality Observations Kaufman [21] 2009 Australia Multicentre, prospective cohort (n=3) Face mask 0 100% No Perez-Padilla [22] 2009 Mexico Retrospective, multicentre cohort (n=98) Face mask n=18 (IMV: n=12) Yes n=7 22 HCW were treated with oseltamivir
None were hospitalised
None of the secondary infections among HCW were severeRello [23] 2009 Spain Multicentre cohort (n=32) Face mask n=8 (33%) 75% No n=8 24 (75.0%) required IMV Djibre [28] 2009 France Case 1: pregnant Face mask 1 0% No 0 Pregnancy population Kumar [24] 2009 Canada Prospective, observational, multicentre cohort (n=168) Face mask n=55 (33%) 85% No 136 (81.0%) patients received IMV DomÍnguez-Cherit [31] 2009 Mexico Prospective, observational, multicentre cohort (n=58) Face mask 0 0 No 0 Miller [29] 2009 USA Monocentre, observational cohort (n=47) Face mask n=13 (3%) 85% No 17% Severe ARDS with MOF in the absence of bacterial infection was a common clinical presentation Li [26] 2010 China Retrospective, monocentre cohort (n=75) Face mask n=33 (44%) n=10 (30%) No 10% Koegelenberg [30] 2010 South Africa Monocentre, observational cohort (n=19) Face mask n=6 (66%) 66.6% No n=13 (68.4%) Winck [36] 2010 Portugal Case report (n=1) Face mask n=1 0 No Esquinas [37] 2010 International NIV Network Survey Prospective, international, observational cohort Face mask No Hajjar [38] 2010 Brazil Monocentre cancer patients, observational study cohort (n=8) Face mask n=8 (50%) n=5 (62.5%) No 100% Cancer patients highlight the severity of the H1N1 pandemic in this vulnerable population and the urgent need to establish specific protocols of care and management strategies designed to face this healthcare challenge Louriz [40] 2010 Morocco Observational, prospective, multicentre cohort (n=186) Face mask n=10 n=10 (100%) 30% Adigüzel [32] 2010 Turkey Observational, monocentre cohort (n=19) Face mask Nasal cannula: n=4 (21.1%) No First study to include nasal cannula Nin [39] 2011 Spain Multicentre, observational, prospective cohort (n=96) Face mask n=43 (45%) 77% No 50% global High mortality, primarily due to refractory hypoxia RÍos [25] 2011 Argentina Face mask n=49 (28%) 94% No Liu [43] 2011 China Retrospective, observational, monocentre cohort (n=62) Face mask n=23 n=3 No n=4 (6.5%) Hypoxaemia, MOF, and a requirement for IMV Timenetsky [46] 2011 Brazil Prospective, observational, monocentre cohort (n=14) Face mask 85.7% 58.4% No 2.1% Grasselli [45] 2011 Italy Prospective, observational, monocentre cohort (n=19) Face mask n=13 n=11 No Frequent IMV Belenguer-Muncharaz [47] 2011 Spain Retrospective, observational, monocentre cohort Face mask and helmet n=10 0 No 0 First study to use a helmet and a face mask Masclans [48] 2012 Spain Prospective, observational, multicentre registry cohort Face mask n=177 n=105 (59.32%) No 0 Best outcome in low APACHE II and SOFA, no vasopressor, lower chest radiograph quadrants and shorter ICU stay Zhang [33] 2012 China Retrospective, observational, monocentre cohort (n=394, including 1 pregnant subject) IMV (n=186) Face mask n=83 n=45 (24.32%) No n=24 (28.91%) Pregnancy population HCW: healthcare workers; IMV: invasive mechanical ventilation; ARDS: acute respiratory distress syndrome; MOF: multi-organ failure; APACHE II: Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential Organ Failure Assessment; ICU: intensive care unit. #: instances of transmission of influenza A H1N1 among HCW.
- Table 3. Contribution to pandemic influenza A H1N1 case series (total n=23) based on country
European countries n=9 Spain n=5 Italy n=1 France n=1 Portugal n=1 Turkey n=1 Asia n=3 North America n=1 Australia n=1 Canada n=1 Latin America n=6 Mexico n=2 Brazil n=2 Chilean-Uruguay n=1 Argentina n=1 South Africa n=1 North Africa (Morocco) n=1 - Table 4. Noninvasive ventilation (NIV) in acute exacerbations of pulmonary tuberculosis (TB) sequelae
First author [ref.] Year Country Study design Type of ARF-TB Interface NIV failure Transmission among HCW# Mortality Observations Home MV after AEPTS Tsuboi [51] 1996 Japan Prospective cohort (n=17) AEPTS in mixed groups Nasal mask 0 No 0 Yes Machida [53] 1998 Japan Retrospective survey (n=58) AEPTS Nasal mask 0 No 0 Yes Prats Soro [60] 1999 Spain Case report (n=1) AEPTS Nasal mask 0 No 0 Yes Schulz [54] 1999 Germany Prospective cohort (n=26) AEPTS Nasal mask 0 No 0 Yes Agarwal [56] 2005 India Cases series cohort (n=3) ARDS and Mycobacterium tuberculosis AEPTS Face mask 0 No 0 No Utsugi [57] 2006 Japan Case report (n=1) ARF, miliary TB and AEPTS Face mask 0 No 0 No Aso [58] 2010 Japan Prospective cohort (n=58) AEPTS Face mask 13.8% No 1.7% 0 No ARF-TB: acute respiratory failure associated with TB pulmonary infection; HCW: healthcare workers; MV: mechanical ventilation; AEPTS: acute exacerbations of pulmonary TB sequelae; ARDS: acute respiratory distress syndrome. #: instances of transmission of Mycobacterium tuberculosis among HCW.
- Table 5. Summary of recommendations for noninvasive ventilation (NIV) during severe acute respiratory syndrome (SARS), H1N1 and tuberculosis (TB) infections
Specific NIV recommendations NIV in TB TB patients are contagious for a relatively long period of time after starting anti-TB treatment (at least 2 weeks) NIV needs a long period of time to improve the respiratory condition in severely ill TB patients NIV patients are exposed to a higher risk of pneumothorax and/or haemoptysis and the lowest pressures should be set NIV in SARS and H1N1 Selection in early stages and mild forms of ARF, such as minimal pulmonary infiltrates and arterial oxygen tension/inspiratory oxygen fraction >250 Exclude in shock or multi-organ failure HCW general recommendations for NIV# TB patients with contagious forms of the disease should be isolated in airborne infection isolation (AII) rooms Air cleaning technologies, such as HEPA filtration and UVGI, should be used HCW entering a room with an infectious TB patient should wear at least a N95 disposable respirator (preferably a FFP3 mask) Negative pressure rooms should be equipped with HEPA (where available) and have anterooms Use full protective clothing as per all aerosol generating procedures including a FFP3 mask when available (N95 masks are second choice), eye protection, a gown, gloves and an apron Strict personal protection equipment for HCW Minimise the number of individuals caring for the patient Strict monitoring of HCW for signs and symptoms of infection Equipment and setting recommendations for NIV# Viral/bacterial filter (99.9997 efficiency) These should be used between the mask/interface and the expiratory port, and at the outlet of the ventilator. In order to reduce the risk of contaminating the ventilator, a bacterial filter should be placed at the expiratory side of the breathing circuit or between the mask and the circuit. It is recommended to choose a model to filter particles 0.3 μm in size Ventilators Double hose tubing (inspiratory and expiratory limb) may be advantageous. Avoid high flow face mask CPAP (open exhalation port) Interface Helmet is preferred if applicable and available; if not, a non-vented face mask may be used For TB patients, select long-term nasal mask ventilation Apply and secure mask before turning on the ventilator Pressure setting Use the lowest possible pressures, e.g. EPAP 5 cmH2O and IPAP <10 cmH2O titrated to respiratory rate and arterial blood gas tensions. When applying the helmet, inspiratory pressures may be at least twice the pressures used with a standard face mask Turn off the ventilator before removing the mask ARF: acute respiratory failure; HCW: healthcare workers; HEPA: high-efficiency particulate air; UVGI: ultraviolet germicidal irradiation; CPAP: continuous positive airway pressure; EPAP: expiratory positive airway pressure; IPAP: inspiratory positive airway pressure. #: these apply to SARS, H1N1 and TB.