A critical shortage of mechanical ventilators is anticipated in many countries, including the United States, because of the ongoing COVID-19 pandemic. A potential emergency solution would be the use of bi-level positive airway pressure (BiPAP). BiPAP may be used in the hospital setting with appropriate precautions for intubated COVID-19 patients experiencing Acute Respiratory Distress Syndrome (ARDS). Use of BiPAP on an emergency basis may delay or obviate the need for invasive ventilation in appropriate COVID-19 patients.This paper discusses the need for expanding ventilation options for patients with COVID-19, how BiPAP can be as an emergency alternative (including algorithms) and recommendations for minimizing aerosolization.
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