UK could benefit from success in other countries in the COVID-19 battle.
Chicago 4/1/2020
As countries continue to venture into the unknown battle against COVID-19, questions arise about the best practices to eradicate the virus and save lives.
The United Kingdom only recently advised residents to observe social distancing – and may have further put patients at risk by using a Continuous Positive Airway Pressure (CPAP) face mask device for treatment. Pulmonologists around the world treating COVID-19 patients warn noninvasive positive pressure ventilation (NIPPV) via face mask is not safe for patients or medical staff.
Clinicians in the UK are more comfortable working with CPAP face masks as they have been using them for a long time.
A better, safer option for all is helmet-based ventilation, which creates a closed system with little or no air leaks, along with an antiviral filter providing another barrier against the spread of coronavirus. This is an obvious benefit to medical personnel who are in constant contact with many patients. Helmets are common in Italy, and hospital staff has had success using them to treat COVID-19 patients.
A helmet also is a better alternative for patients -- they can eat and drink without creating an air leak. It also is more comfortable and avoids the breakdown of skin experienced by wearing face masks for a long period of time.
A three-year study at the University of Chicago showed patients using helmet-based ventilation improved faster, had fewer days in the ICU and hospital and were less likely to need intubation. Doctors in Italy have had 20-35% success using helmet-based ventilation among COVID-19 patients. According to international guidelines for COVID-19 patients, a helmet is preferred when applying noninvasive positive pressure ventilation (NIPPV).
Pulmonologists who have worked with COVID-19 patients in respiratory distress have warned about spreading the infection using masks or high-flow nasal cannulas.
Excerpt from: “International Pulmonologist’s Consensus on COVID-19” Chief editors: Dr.Tinku Joseph (India), Dr. Mohammed Ashkan Moslehi (Iran).
A CPAP device was re-engineered by Formula One engine manufacturer Mercedes with University College London engineers and clinicians, CNN reported.
The United Kingdom is testing 100 of these redesigned devices on COVID-19 patients this week. The CNN article states CPAP devices have been used in China and Italy to treat COVID-19 patients and that roughly half of patients have avoided the need for ventilators. What the article doesn’t say is that in Italy, medical staff use helmets for NIV.
A BBC Newshour interviewer asked Professor Rebecca Shipley about this concern. Shipley is director of the Institute of Healthcare Engineering at University College London, who collaborated on the new Mercedes CPAP device.
“Obviously, the protection of health care workers is exceptionally important,” Shipley said. Shipley said all the indications -- both within the UK, and, for example in Italy and China – suggest that if health care workers are wearing the appropriate personal protective equipment, the chance of transmission is extremely low.
Based on Shipley’s comment, every listener should ask these questions:
Italy uses helmets, so health care workers are more protected. How does that factor into face masks?
How do medical workers stay safe with a shortage of personal protective equipment (PPE) around the world?
Based on data from Italy, patients require days of NIPPV to recover. Face masks are difficult for patients to tolerate. Why choose a face mask design?
While these questions likely were asked during the development of the redesigned CPAP face mask, it looks the same and continues to present problems for patients and doctors.
Increasing amounts of time, money, and effort are being expended to battle and conquer COVID-19. If we can’t adapt to new guidelines – and learn from those who already have been in the fight, we are not just losing a battle, we are losing the war.