Medical professionals caring for patients with coronavirus disease 2019 (COVID-19) are at high risk of contracting the infection
Aerosol-generating procedures, such as non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), bag-mask ventilation, and intubation are of particularly high risk.2 ...All medical personnel involved in the management of patients with suspected COVID-19 must adhere to airborne precautions, hand hygiene, and donning of personal protective equipment. All aerosol-generating procedures should be done in an airborne infection isolation room. Double-gloving, as a standard practice at our unit, might provide extra protection and minimise spreading via fomite contamination to the surrounding equipment after intubation.
...to avoid confusion and potential harm, we do not recommend using NIV or HFNC until the patient is cleared of COVID-19. Airway devices providing 6 L/min or more of oxygen are considered high-flow5 and we discourage their use if an airborne infection isolation room is unavailable.
(Пациентам на заметку: врачи не рекомендуют использование масок и канюлей исходя не из нужд пациентов, а из того, что при их использовании возрастает риск для инфицирования медперсонала, ввиду аэросолизации выделяемого возбудителя)
We recommend that endotracheal intubation is done by an expert specialised in the procedure, and early intubation should be considered in a patient with deteriorating respiratory condition. For all cases, backup airway plans should be ready.We recommend avoiding bag mask ventilation for as long as possible; and optimising preoxygenation with non-aerosol-generating means. Methods include the bed-up-head-elevated position, airway manoeuvres, use of a positive end expiratory pressure valve, and airway adjuncts. If manual bagging is required, we suggest gentle ventilation via a supraglottic device instead of bag mask ventilation.
Although no robust evidence is available to show that the use of supraglottic devices are less aerosol-generating than BMV, the devices are easy to insert and can achieve sufficient seal pressure. They also help to spare manpower and thus reduce staff exposure.