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
        Double hose tubing (inspiratory and expiratory limb) may be advantageous. Avoid high flow face mask CPAP (open exhalation port)
        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.