| 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.