Noninvasive Mechanical Ventilation in High Risk Infections, Mass Casualty and Pandemics

Preface
Contents
Abbreviations
Part I: NIV and ARF: Overview, Transmission and Physiopathology, Equipment and Technologies
ARF Mechanical Ventilation and History in Pandemics
Introduction
Spanish Flu
Polio
Ebola
Future Perspectives and Conclusions
Conclusion
References
Hospital Organizations
Introduction
Organization
Laboratory and Diagnostic Imaging Services
Triage
Infection Control
Healthcare Workers
Recent TFMCC Recommendations for Staff Organization
Increasing ICU Bed Capacity
Management of Respiratory Failure
Maximize the Available Supply
Other Potential Solutions for Mechanical Ventilator Shortages
Conclusions
References
Noninvasive Ventilation in Patients with Infectious Diseases in the Emergency Room
Introduction
Is the NIV the First Option in Infectious Disease Patients?
NIV during the Influenza A (H1N1) Pandemic
NIV during the COVID-19 Pandemic
NIV and Immunodeficient Patient
Safety of Healthcare Professionals
References
Noninvasive Mechanical Ventilation After Chemical Disasters
Introduction
Analysis of Main Topics and Discussion
Nerve Agents
Vesicants
Cyanide
Pulmonary Agents
Riot Control Agents
Irritant Fume Exposure
Role of Noninvasive Mechanical Ventilation
Conclusion
References
Noninvasive Ventilation in Patients with Infectious Diseases Outside Intensive Care Unit
Introduction
The Necessity of Setting outside the ICU during a Pandemic
The Negative Pressure Rooms
Implications for Healthcare Worker
The Use of NIV in General Ward and Sub-Intensive Unit
Conclusion
References
Organization of a Noninvasive Mechanical Ventilation Unit for Immunocompromised Patients
Introduction
Immunocompromised Scenarios
Contraindications of NIV
Hospital Resources Required for NIV
Personnel Responsible for NIV
Training
Monitoring of NIV
Administrative Participation
References
Transmission of Severe Acute Respiratory Syndrome During Intubation and Mechanical Ventilation
Introduction
Contamination Risk During Oxygen Therapy
Nasal Cannula and Oronasal Masks
Nebulizers, NIV, and HFNC
Contamination Risk During Invasive Ventilation
Contamination Risk During ECMO
Intubation-Related Contamination Risk
Healthcare Workers’ Protective Equipment
Summary
References
The Rationale of Acute Respiratory Failure in High-Risk Infections
Introduction
High-Flow Nasal Oxygen (HFNC)
Use of HFNC Combined with Prone Positioning
Noninvasive Ventilation
Interface
Efficacy of NIV in Pulmonary Infections and Pandemics NIV in SARS
NIV in Influenza A H1N1 Infection
Tuberculosis
COVID-19
Aerosol Droplet Dispersion and Infection Risk Spread with NIV
High-Risk Infections and Healthcare Worker Protocols
Oxygen Therapy
Invasive Ventilation
Conclusion
References
Rationale of ARF Approach in Mass Causalities
Introduction
Discussion: Analysis
Conclusion
References
NIV–Pathophysiology–High-Risk Infection, Microbiology
Introduction
Discussion
References
Nasal High-Flow Oxygen Equipment
Introduction
HFNC: Accessories and Setting Up
Temperature Setting
Flow Rate Setting
Oxygen Setting
Monitoring
Bioaerosol Dispersion and Safe Distance During HFNC in Mass Infections
The Rationale for the Use of HFNC
Acute Hypoxemic Respiratory Failure (AHRF)
Acute Hypercapnic Respiratory Failure
Chronic Airway Disease
Avoidance of Intubation
HFNC and Preoxygenation
NFNC in the Post-Extubation
Palliative Care
HFNC Use in COVID-19 Patients
Conclusion
References
NIV-CPAP Systems
Introduction
The History of NIV
CPAP: Physiology
Indications and Contraindications
Equipment and Mask Interface
Clinical Significance
Conclusion
References
NIV in High-Risk Infections, Mass Casualty, and Pandemics: What Interface?
Introduction
General Features of NIV Interface/Interface Choice Based on Type of Ventilator
Vented Mask
Non-vented Mask
NIV Interface and Potential Aerosol Production
Requisite for Ideal NIV Interface During High-Risk Airborne Infections
Types of Interfaces for NIV in High-Risk Infection Mass Casualties and Pandemics
Total Face Mask or Full-Face Mask
Helmets
Standard Face Mask/Oronasal Mask
Prevention and Management of Interface-Related Complications During High-Risk Airborne Infections
Air Leaks
Facial Skin Irritation or Pressure Sores
Oral or Nasal Dryness
Interface and Patient-Ventilator Asynchrony
Conclusion
References
NIV: Noninvasive Ventilation via Different Face Masks/Helmets
Introduction
History of Helmet Interface
Bench Studies of Helmet Interface
Helmet Interface in Pandemics
Severe Acute Respiratory Syndrome (SARS-CoV, 2002–2003)
Influenza A Virus (H1N1, 2009–2010)
Middle East Respiratory Syndrome (MERS-CoV, 2012)
Coronavirus Disease 2019/COVID-19 (SARS-CoV-2, 2019)
References
Humidification and Aerosol Therapy During Non-Invasive Ventilation
Introduction
Physiological Concepts
Humidification Devices
Humidification Settings
Factors That Effect Humidification
Infection Control
Pressure Ulcer
Aerosol Delivery
Conclusion
Aerosol Therapy
Introduction
Types of Aerosol Therapy
Factors Determining the Delivery
Optimum Position of Device
Device
Ventilator Settings
Nebulization Mode
Humidification and Aerosol Delivery
Conclusion
References
NIV Models to Assess Air and Particle Dispersion
Aerosol, Particle, and Aerosol-Generating Procedures
Aerosol Dispersion in NIMV
High-Flow Nasal Oxygen Therapy (HFNO)
Noninvasive Ventilation (NIV) via Masks
Bag-Valve-Mask Ventilation (BVMV)
References
Airborne Contamination of Healthcare Workers During Noninvasive Ventilation, Aerosol or Oxygen Delivery, and Airway Clearance Techniques
Introduction
Rational
Dispersion and Deposition into the Lungs
What About the Different Modalities of Treatment?
To Keep in Mind
References
Part II: Clinical Experience in Adults
Noninvasive Ventilation in Severe Acute Respiratory Syndrome
Introduction
Severe Acute Respiratory Syndrome (SARS)
Infectious Risk of NIV in SARS
Effectiveness of NIV in SARS
Conclusion and Future Perspectives
References
NIV in Avian Flu
Introduction
Severe AIV Infection in Humans
Management Respiratory of Patients with Avian Influenza Infection
Infection Prevention and Control Measures
Conclusion
References
Noninvasive Ventilation in H1N1 Influenza
Introduction
Issues with the Use of NIV Over Invasive Ventilation
Ventilatory Factors
NIV and Droplet Generation
Prognostic Factors of NIV Success
Evidence of NIV Use in H1N1 Patients
Conclusion
References
Noninvasive Ventilation Support in COVID-19
Introduction
Pathophysiologic Issues
Published Clinical Experience
Prone Position in Awake Patients
Safety Issues: NIV Outside the ICU and Risk of Staff Contamination
Conclusions
References
NIV in Acute Immunodeficiency Diseases
Immunodeficiency
Lung Involvement
NIV (Noninvasive Ventilation) in Acute Immunodeficiency Disease
Evidence of the Literature
Conclusions and Perspectives
References
Noninvasive Ventilation in Legionnaires’ Disease
Introduction
Treatment
NIMV in Legionnaires’ Disease
References
NIV in Tuberculosis
Introduction
Tuberculosis in Intensive Care Unit
Noninvasive Ventilation in Tuberculosis
Infection Control in the Intensive Care Unit
Conclusion
References
Infant Nasal Bubble Continuous Positive Airway Pressure (CPAP) in Resource-Limited Settings
Introduction
Patient Selection
General Indications
Other Medical Considerations
Age Recommendations
Equipment and Design
Supportive Care
Weaning or Discontinuation of Bubble CPAP
Facility Considerations
Conclusions
References
Part III: High Risk Infections in Pediatrics and Newborns
NIV-Nasal High Flow in High-Risk Pediatric Neonatology
Introduction
NIV in Newborns with Respiratory Distress
The Type of NIV Methods
Nasal Continuous Positive Airway Pressure (NCPAP)
Nasal Intermittent Positive Pressure Ventilation (NIPPV)
Heated Humidified High-Flow Nasal Oxygen Therapy (HHHFNOT)
Nasal High-Frequency Oscillator Ventilation (NHFOV)
NIV in Newborns During a Pandemic
Neonatal Cases in 2009 H1N1 Pandemic, 2012 SARS Outbreak, and COVID-19 Pandemic
Conclusion
References
NIV-Nasal High Flow in High-Risk Pediatric Infections
Introduction
Mechanism of Action of HFNO Therapy
Recommended Flow Setting and Cannula Size for HFNO Therapy in Pediatric Patients
HFNO Versus Continuous Positive Airway Pressure (CPAP) in Pediatric Sepsis
Safety Issues in Pediatric Patients
Conclusion
References
Part IV: NIV Guidelines, Protocols and Outcome, Strategies to Control Infections in Hospitals
Guidelines and Protocol
Introduction
NIV-Related Contagious Risk in Infective Diseases
What About the Risk of Transmission of Contagious During NIRT?
Strategies to Reduce the Risk of Infection Transmission
NIRT-correlated measure
Implications for Personnel Behavior
Conclusions
References
NIV-Prognostic Factors in High-Risk Infections
Introduction
Background Information
Why There Are Chances of NIV Failure over Invasive Ventilation?
Evidence of Studied Prognostic Factors
Conclusion
References
Negative Pressure Rooms or Well-Ventilated Rooms
The Concept of Isolation Precaution and a Historical Review
Isolation Rooms
The Behaviour of Aerosols in a Room
Transmission of Infection
Ventilated Room
Natural Ventilation
Modular Negative Pressure Isolation Room Design
Hybrid or Mixed-Mode Ventilation
Assessing Ventilation Performance
Mechanical Versus Natural Ventilation for Infection Control
The Association Between Ventilation and Infection
The Cotugno Hospital (Naples) Experience
Ventilation: Technological Adaptation
References
Bacterial and Viral Filters to the Expiratory Circuit
Introduction
Microorganism Sizes, Particle Classification, and Pathogenesis
Filter Technology, Composition, and Aims
Filtration Standards
Cross Contamination’s Risk
Clinical Practice
Risks
Occlusion Risk
EtCO2 Risk
Filters in SARS-COV-2 Era
References
Personal Protection Equipment for Healthcare Workers
Introduction
Steps of Using Personal Protective Equipment
Features of Personal Protective Equipment
Proper Use of Personal Protective Equipment
References
Part V: Failure NIV Approach
Failure Nasal High-Flow Oxygen in High-Risk Infections
Introduction
Various Factors for Failure
Before Applying HFNC
After Applying HFNC
Infection Concerns During HFNO
Conclusion
References
Failure of Noninvasive Ventilator Approach in High-Risk Infections: Key Determinants
Introduction
Failure Criteria
Key Determinants of NIV Failure
Patient-Related Risk Factors
In Covid-19 Patients
In Influenza Patients
Other Risk Factors
Timing of NIV
Location of NIV
Training of Staff
Choice of Ventilator
Choice of Interface
Monitoring Requirements
Sedation
Early Predictors of NIV Failure: HACOR Score
Summary
References
Endotracheal Intubation in High-Risk Infections
Introduction
Modifications at the Patient’s End
Modifications at Airway Operator’s End
Environmental Modifications
Instruments
Crisis Management
Conclusion
References
Airway Management in Failure Noninvasive Ventilation in High-Risk Infection
Introduction
Monitoring on NIV
Discontinuation of NIV
Airway Management of NIV Failure
Conclusion
References
Radiology Findings in Acute Respiratory Failure in Common High-Risk Infections
Introduction
Radiological Findings Specific to Common Pneumonia Agents
Bacterial Pneumonias
Viral Pneumonias
Conclusion
References
Part VI: Procedures in Noninvasive Ventilator Approach. Guidelines and Recommendations; Effectiveness in the Treatment of ARF
Bronchoscopy and Noninvasive Ventilation in High-Risk Infections
Introduction
Discussion
The Use of Bronchoscopy and Noninvasive Mechanical Ventilation
Ensuring Safety in the Workplace
The Equipment
The Technique and the Procedure
References
Summary of Effectiveness of NIV in the Treatment of Acute Respiratory Failure
Introduction
Role of NIV in Nonhypercapnic Acute Respiratory Failure
Cardiogenic Pulmonary Edema
Immunocompromised Patients
Postoperative Patients
De Novo ARF
Endoscopic Procedures
Thoracic Trauma
Pandemic Viral Illness
Role of NIV in Hypercapnic Acute Respiratory Failure
COPD Exacerbation
Asthma Exacerbation
Bronchiectasis
Neuromuscular Diseases
Conclusion
References
Part VII: NIV in the Treatment of ARF. Biological and Non-biological Mass Causalities
Hospital Bioterrorism Response Programs
Possible Agents
Public Health Emergency Preparedness and Response to the Bioterrorist Attack
Prehospital Response, Triage, and Transport
Hospital Response
Arrival Process
Triage Process
Isolation Practices for Infection Control
Isolation Practices for Airborne Infections
Infection Control for High-Risk Procedures
Staff Availability
Supplies and Equipment
Availability of Spaces
Infection Control
Laboratory Capacity
Decontamination Unit
Personal Protection
Inhalation
Conclusion
References
Influenza and Other Airborne Infections
References
Noninvasive Mechanical Ventilation in Massive Intoxications
NIMV Use in Bioterrorism
NIMV Use in Chemical/Thermal Intoxication
References
NIV in Politrauma
Introduction
Examples of Use of NIV in Patients Treated in ED
Preoxygenation Before Intubation
Injuries
Chest Trauma
Head Injuries
Invasive Procedures
Respiratory Failure
Heart Failure/APE
Masks
Sedation of a Trauma Patient
Patient Monitoring
Risk of NIV Failure
Proposed NIV Ventilation Scheme for ED
Summary
References
Noninvasive Mechanical Ventilation in Burn
Introduction
Pathophysiology and Diagnosis
Inhalation Injury
Smoke Inhalation Injury
Acute Lung Injury
Systemic Toxicity
NIV for Treatment of Burns
Prophylactic Use of NIV
Early Extubation and Avoiding Re-Intubation
Interface
Device Settings
Conclusion
References
Noninvasive Mechanical Ventilation After Chemical Disasters
Introduction
Analysis of Main Topics and Discussion
Nerve Agents
Vesicants
Cyanide
Pulmonary Agents
Riot Control Agents
Irritant Fume Exposure
Role of Noninvasive Mechanical Ventilation
Conclusion
References
Noninvasive Mechanical Ventilation in Chemical Disasters
Introduction
Nerve Agents [2, 3]
Cyanide
Pulmonary Agents
Vesicants
Riot Control Agents
Role of NIMV
Conclusions
References
Part VIII: Outcome, Ethics, Palliative and Do Not Endotracheal Intubation
Outcome: Noninvasive Ventilation Approach in High-Risk Infections
Introduction
NIV Settings and Choice of Interface
Current Evidence on Various High-Risk Infections
NIV in Pulmonary Tuberculosis
NIV in Patients with Severe Acute Respiratory Syndrome
NIV in Patients with Influenza A (H1N1) Virus Infection
NIV in Patients with COVID 19 Infection
Conclusion
References
Ethical Dilemmas and Do Not Endotracheal Intubation Orders
Introduction
Ethical Evaluation
Clinical Evaluation
Palliative Care
Conclusive Remarks
References
Pandemic Influenza Management and Control Policies: Hospital Coordination During Pandemics
Introduction
Importance of ICUs
Committees
Hospital Organization
Personnel Management
Patient Discharge
NIV During the COVID19 Pandemic
Handling of Protocols
References
Part IX: Future Research About Noninvasive Ventilator Approach in High Risk Infections, Mass Casualties and Pandemics
NIV Lesson for Last Pandemics and for the Future
Introduction
Ventilatory Strategy in H1N1
Approaches to Ventilating SARS-CoV-2
High-Flow Nasal Cannula (HFNC)
Prone Position
Do Different Clinical Phenotypes Require a Different Approach?
Conclusion
References