Today, we will talk about COVID-19 and the use of NIV and discuss the risk on health care providers. Health care personnel caring for patients with COVID-19 are at high risk of infection. They should always be aware of this risk. Due to the nature of the disease, some of those patients will need to be placed on NIV or receive chest physiotherapy. Simons et al. found in a study they did to evaluate the droplet dispersion during non-invasive ventilation that NIV and chest physiotherapy are droplet, not aerosol, generating procedures producing droplets of 10 micrometer in size. Due to their large mass, most fall out onto local surfaces within 1 meter. The only device producing an aerosol was the nebulizer and the output profile is consistent with nebulizer characteristics rather than dissemination of large droplets from patients. These findings suggest that health care workers providing NIV and chest physiotherapy working within 1 meter of an infected patient should have a higher level of respiratory protection but that infection control measures designed to limit aerosol spread may have less relevance for these procedures. While all NIV delivery methods carry the same risk of droplet spread, a recent study showed that in the normal lung condition exhaled air dispersion along the sagittal plane increased from 186 to 264 mm and from 207 to 332 mm when CPAP was increased from 5 to 20 cm of water via RESP Ironics and ResMed nasal pillows, respectively. Exhaled air distances increased from 65 to 172 mm when high flow nasal cannula was increased from 10 to 60 liters per minute. Air leakage to 620 mm occurred laterally when high flow nasal cannula and the interface tube became loose. From this we know that the highest risk for a health care provider is to be within 1 meter from the patient. This risk may increase or decrease according to the NIV interface used and the pressure levels. Now let's try to answer some of the main questions that providers around the world had been asking about the use of NIV for COVID-19 patients with respiratory failure and increased oxygen needs. The first question is should we use NIV for those patients? And the answer is yes, NIV can be used, but maximum personal protective equipment recommendations and regulations should be followed. But if we are to use it, what is the best interface that will decrease the spread of respiratory droplets? Intubate is preferred if applicable and available, if not, a non-vented face mask may be used. When applying the helmet, inspiratory pressures may be at least twice the pressures used with the standard face mask. But when should we stop and intubate? Although this is hard to answer as there is still no reliable data available, the information coming from areas with high caseloads like Italy and Seattle indicates that the progression to full respiratory failure is quick, and early intubation may be of value. So in summary, NIV can be used to care for patients infected with COVID-19 who has respiratory failure and increased oxygen needs. When using NIV personal protective equipment regulation and recommendations should be followed. And early intubation may be beneficial. It is important to remember that with increased level of CPAP, the dispersion of air increases. Thank you.

non-invasive ventilation

risk to healthcare providers

COVID-19 patients

droplets and aerosols

NIV interface and pressure levels