Proposed Clinical Flow

  1. Do not use IC rated ventilations to start off with. When Patients need a kind of respiratory support, use CPAP machines with adapted masks (more later)
  2. Free all IC rated ventilation units for those patients who are not (yet) in a critical state (estimated to 6-10%)
  3. Step from CPAP to IC ventilation only for critical situation

Indications for mechanical ventilation

Non-invasive ventilation (NIV) therapy provides both oxygenation and ventilation support and can enable physicians to tailor ventilation pressures and flows to match the patient’s breathing patterns and needs. Vigilance is required to ensure timely endotracheal intubation and positive pressure ventilation if a patient’s clinical status deteriorates. If a patient develops acute respiratory failure with documented or suspected COVID-19 infection fails trials of noninvasive respiratory, they may require endotracheal intubation and positive pressure mechanical ventilation.

Benefits of CPAP (Continuous Positive Airway Pressure)

  • Increase amount of inspired oxygen
  • Decrease workload of breathing
  • Reduces need for intubation
    • Intubation requires ICCU (Intensive and Critical Care Unit) stay
      • Increased exposure to risk associated with complications due to intubation
      • Increases overall hospital length of stay

Usage of CPAP Devices

Due to the proposed Clinical Flow, there is a need for supply of CPAP ventilation systems, but then with proper masks to ensure a proper pressure in the lungs and to avoid air leakage and thereby further spreading of the virus. In order to do that, four things are needed (reference and numbered in Picture):

  1. A CPAP machine or hospital air supply which creates enough inflow of approximately 13 l/m (to be checked)
  2. A mask with enough sealing so that the incoming airflow will be directed to the lungs and not leak out.
  3. A connector which separates the inflow from the outflow in the mask (see important comments later)
  4. A Filter to prevent contamination in the outflow
  5. A pressure control valve which ensures that the pressure in the lung will not rise to dangerous values; it should stay between 5 upto 50 cm of water

Recommended setting according to our experience and ventilation mode

  • CPAP: PEEP between 6-10 cm H2O (be aware of possible leakage from expiratory valve!)
  • BiPAP: PEEP is recommended with a minimal inspiratory assistance (e.g: PEEP 8 cm H2O, AI 4 cm H2O) and to adapt O2 according to sp02 (<92%)

WARNING: The solution described in this document is an EMERGENCY solution that could potentially be applied answering the challenges of the current COVID-19 crisis. It is NO regular approved method that has been clinically validated and contains (some tailor made) components that do not have a CE mark for clinical usage! Application of the solution and its components is the full responsibility of the medical professional responding to the COVID-19 crisis