Trimming the need for invasive ventilation: pragmatic critical

BMJ case reports · Sep 2020

Case Reports

Trimming the need for invasive ventilation: pragmatic critical care during the COVID-19 pandemic.

COVID-19 has challenged all medical professionals to optimise non-invasive positive pressure ventilation (NIV) as a means of limiting intubation. We present a case of a middle-aged man with a voluminous beard for religious reasons who developed progressive hypoxic respiratory failure secondary to COVID-19 infection which became refractory to NIV. After gaining permission to trim the patient's facial hair by engaging with the patient, his family and religious leaders, his mask fit objectively improved, his hypoxaemia markedly improved and an unnecessary intubation was avoided. Trimming of facial hair should be considered in all patients on NIV who might have any limitations with mask fit and seal that would hamper ventilation, including patients who have facial hair for religious reasons.

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- Connor P Oates, Sarah A Goldman, Gennaro Giustino, and Martin E Goldman.
- Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA connor.oates@mountsinai.org.
- BMJ Case Rep. 2020 Sep 8; 13 (9).
AbstractCOVID-19 has challenged all medical professionals to optimise non-invasive positive pressure ventilation (NIV) as a means of limiting intubation. We present a case of a middle-aged man with a voluminous beard for religious reasons who developed progressive hypoxic respiratory failure secondary to COVID-19 infection which became refractory to NIV. After gaining permission to trim the patient's facial hair by engaging with the patient, his family and religious leaders, his mask fit objectively improved, his hypoxaemia markedly improved and an unnecessary intubation was avoided. Trimming of facial hair should be considered in all patients on NIV who might have any limitations with mask fit and seal that would hamper ventilation, including patients who have facial hair for religious reasons.© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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Trimming the need for invasive ventilation: pragmatic critical care during the COVID-19 pandemic.

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