The Australasian Sleep Association has updated its consensus statement on the safe use of respiratory therapy and NIV to minimise aerosolisation of COVID-19.

The statement acknowledges both the relatively low rates of community transmission of COVID-19 in Australia and New Zealand and the unique challenges of managing hotel quarantine for people returning from overseas and at much higher risk of COVID-19.

Some of the recommendations include:

Nebulisers

• Nebulisation of bronchodilators and steroids is not necessary for most patients and should be replaced by metered dose inhaler (MDI) with a spacer.
• People with suspected or known COVID-19 requiring use of nebulisation for acute medical symptoms should be managed in the highest level isolation available. Given this level of care is not available at home or in hotel quarantine, transfer to an acute hospital for expert care is required.

High flow oxygen (hospital based)

• The lowest flow rate of oxygen should be used to maintain oxygen saturations to minimise risk of viral aerosolisation and/or dispersal.
• If HFNO is to be used in a patient with suspected or known COVID-19, the patient should be fitted with an interface to minimise leak in the highest level of isolation available (class N-negative pressure room is optimal), with airborne and droplet PPE precautions for health care personnel.

NIV for acute or chronic respiratory failure

• Patients with suspected or confirmed COVID-19 requiring NIV (including those with COPD, obesity hypoventilation syndromes etc), should use double-limb non-vented masks with an expiratory filter in the circuit.
• Patients should be managed in a negative pressure room if available. Alternatively, in a single room with the door closed with room ventilation optimised and portable HEPA filter. Airborne and droplet PPE including N95 masks must be used.

CPAP for sleep disordered breathing

• CPAP should be avoided in those with suspected or proven COVID19 unless clinically necessary.
• Most people using CPAP for obstructive sleep apnoea who are not acutely unwell can cease CPAP for the period of hotel quarantine without significant adverse effects.
• Most people using CPAP at home for obstructive sleep apnoea who are not acutely unwell can cease CPAP if they develop viral symptoms, or are suspected or confirmed as having COVID-19 infection.

The statement included additional information on the management of paediatric patients.

It noted that while healthy children appear less susceptible to COVID-19, there are vulnerable risk groups and children may be asymptomatic.

“It is recommended that children who are using aerosolising therapies such as CPAP/NIV or require such therapy to be implemented to treat acute respiratory disease, are considered high risk of spreading disease,” it said.

Early COVID-19 testing for this group will be important at the time of admission to hospital and children should be managed as if positive, with appropriate PPE use and isolation, until results are available.