Noninvasive Ventilation Recommended During Epidemics

Contrary to current policies recommending that noninvasive ventilation be avoided during an infectious outbreak, a new commentary argues that it should in fact be preferred in this setting.

John McCracken, M.D., a respiratory therapist at Peterborough Regional Health Center (ON, Canada) and Karen Burns, M.D., of St. Michael's Hospital (Toronto, ON, Canada) commented that during the severe acute respiratory syndrome (SARS) epidemic--which in early 2003 spread from the Guangdong province of China to rapidly infect individuals in some 37 countries around the world--the suggestion that noninvasive ventilation may increase the risk of disease transmission was considered a sufficient justification to avoid its use. However, in the six years since then (according to the two researchers), no convincing evidence has substantiated that theory. On the other hand, during the same time noninvasive ventilation has been proven to save the lives of some patients in acute respiratory failure; in fact, because suitable candidates for noninvasive ventilation avoid complications associated with endotracheal intubation, they have better outcomes compared to similar patients who are ventilated invasively. The commentary was published ahead of print on September 28, 2009, in the Canadian Medical Association Journal (CMAJ).

"It is in no one's best interest for patients to undergo endotracheal intubation in cases where it could be avoided,” concluded the authors of the commentary. "Given the available evidence, the precautionary principle would direct us toward the use of noninvasive ventilation during an epidemic.”

Prohibitions against noninvasive ventilation were implemented during the SARS outbreak because it was thought that flow from the mask increased the risk of infectious transmission to staff. Since then, the World Health Organization, the United Kingdom's National Health Agency, the Hong Kong Lung Association, the American Association of Respiratory Care, and other bodies have all published guidelines that treat noninvasive ventilation as a high-risk procedure.

Related Links:
Peterborough Regional Health Center
St. Michael's Hospital