Noninvasive ventilation (NIV), continuous positive airway pressure (CPAP) and high flow nasal cannula (HFNC) can be used as the first line of treatment in COVID19 patients with respiratory failure, postponing and maybe even avoiding the need for intubation and mechanical ventilation (1) . Recent systematic review and meta-analysis demonstrated that HFNC reduces the need for intubation compared with conventional oxygen with no change of the death risk or ICU length of stay (2) (3) , while no direct evidence supports the use of NIV due to a high failure rate (4). However, when resources become limited with no option of invasive ventilation, the use of NIV may be justified. The major caveat of using noninvasive respiratory support in the face of the COVID19 pandemic is the generation of aerosols composed of small virus containing particles which may remain suspended in the air, with increased risk of health care workers (HCW) (7-8). The risk of aerosolization depends on many variables, including duration of use, flow velocity, mask leakage and patient coughing and cooperation.
At the current crisis with a limited number of ventilators and of negative pressure facilities we developed a novel way to reduce, and even eliminate, this exposure to potentially dangerous aerosol by using a constant flow canopy over the upper part of the patient bed, thus creating a confined area surrounding the patient in which non-invasive respiratory support can be safely used. In order to assess the satisfaction of the medical staff in the corona unit from the system we asked 9 physicians and nurses to fill a short 6 questions questioner. The overall impression score of the system was 9.1 (out of 10).
In summary this innovative negative pressure canopy allows us to administer NIV, CPAP or HFNC to patients with moderate to severe lung injury due to SARS-CoV-2 infection with minimal risk to HCW. The system has been installed in the Corona unit of the Carmel, Lady Davis MC, Haifa Israel.
The constant flow canopy system.