• NIV/CPAP  is NOT an Aerosol Generating Proceedure (AGP) [As of Sept 2022]
• CPAP/EPAP levels of 8-15cmH₂O is suggested to work well by the Italian society of Emergency medicine
• BTS has released the guidance – HERE 
  •  Masks 
    • Well-fitting oronasal facemasks, masks over the total face, or helmets should produce least droplet dissemination. 
    • Vented masks could worsen contamination of the environment 
    • Any patient on acute NIV should be managed with a non-vented mask and an exhalation port in the circuit. 
    • Ensure that the ventilator mode employed supports the use of non-vented masks and exhalation ports. 
    • Sequence of actions: NIV mask on >ventilator on; ventilator off > NIV mask off. 
  • Filters 
    • A viral/bacterial filter should be placed in the circuit between the mask and the exhalation port (Figure below). 
    • This viral/bacterial filter can replace any filter at the machine end of the circuit. 
    • Viral/bacterial filters should ideally be changed every 24 hours or sooner. (There is a risk that they will become wet due to exhaled gas and that this may increase resistance to flow.) 
    • An external humidifier must not be used. 
    • Blocked filters can be mistaken for clinical deterioration; this issue is remedied by changing filters. 
  • Oxygen – entrained at patients end (on mask

Review

• • • Review at 2 hours
      • Stable – continue CPAP/NIV
      • Deteriorating –  the patient will likely die with ought intubation, escalate or palliate.

Destinations

• • • Failing on NIV/CPAP – Consider either escalation to intubation OR palliation
    • Maintaining Oxygenation – At CRH negative pressure room, at HRI side room acute floor