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Recent clinical guidelines regarding the use of home non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP) during the COVID-19 epidemic have tried to balance the risks of stopping NIV or CPAP against the unknown potential risk of increased aerosol-related transmission to family and carers.1 2 We read with interest views put forward by Barker et al 3 but feel that wider aspects need consideration, and for NIV and CPAP separately.
NIV use: NIV is primarily used for those with previous, or at risk from, hypercapnic respiratory failure (neuromuscular disorders, chest wall deformity, obesity or underlying lung disease, for example, COPD). Stopping home NIV risks the return of symptoms (lethargy, headache, dyspnoea and confusion), increased patient and family anxiety and precipitating life-threatening acute hypercapnia, which is likely to result in hospital admission, patient exposure to …
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