Use of paediatric viral filters (filter) and combined heat moisture exchange / filter (HME/F) during the COVID-19 pandemic

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Key points

  • Do not use a Filter or HME/F in newborns due to dead space concerns.
  • Remove a Filter or HME/F if ventilation is suboptimal for infants and children.
  • Choose the smallest available dead-space filter for weight range if one is required.
  • If ventilation with this equipment continues beyond initial rescue, the CO2 should be checked to ensure it is not too high, and the filter may be removed if there is a need to reduce dead-space.

Background

  • Airborne precautions must be used for aerosol-generating procedures and treatments for patients with suspected or confirmed COVID-19.
  • Measures to reduce spread of aerosols include use of filters, cuffed endotracheal tubes and modified intubation techniques as well as rigorous training, planning and teamwork.

DO NOT USE a viral filter or Heat Moisture Exchanger/Filter in newborns – refer to Safety Notice 006/20: Use of Viral Filters for Repiratory Care in Neonates

REMOVE a viral filter or Heat Moisture Exchanger/Filter if ventilation is suboptimal for infants and children.

Assessment

  • Brands of viral filters and HME/Fs differ in dead space volume, direction of flow and filtering capacity limited by minimum and maximum tidal volumes and flows. Match patient needs with equipment recommendations.
  • for ventilator circuits
    • follow manufacturer instructions for correct placement of bacterial/viral filters, flow and ETCO2 sensors
      (most devices have a side port for sidestream ETCO2 monitoring)
    • use a viral filter in a humidified (‘wet”) ventilator circuit instead of a HME/F.

Examples of viral filters (if a filter is recommended and is safe to use)

Type Filter or HME maximum volumeExamples
Self-inflating bag 240mL
(young infant <6kg)
10mL
  • Medtronic DAR™ Infant − Pediatric Electrostatic Filter HME
  • Koala Infant HME/F
Self-inflating bag 500mL
(paediatric ≈4-25kg)
15mL
  • Medisize Hygrovent Child HMEF
  • Medtronic DAR™ Infant − Pediatric Electrostatic Filter HME Small
Self-inflating bag 1500mL
(“Adult” >25kg)
50mL
  • PALL Ultipor® 25 Filter (Only – No HME)
  • Koala Adult HME/F
  • Medisize Barr-vent S Filter (Only – NO HME)
  • Medtronic DAR™ Adult − Pediatric Electrostatic Filter HME (Small)
Infant T-piece Resuscitators
(e.g.Neopuff)
10mL
(use only if required)
  • Medtronic DAR™ Infant−Pediatric Electrostatic Filter HME SMALL
  • Koala Infant HME/F
Nitrous Circuit

HME/F examples

Neonatal Ventilator Circuit <10kg

Self-inflating bag 240mL (Neonatal 2-6kg)

T-piece resuscitator (e.g. Neopuff™)

8 to 10mL dead space or smaller bi-flow viral filter (examples below)

KOALA INFANT HMEF
KOALA INFANT HMEF
Medtronic DAR™ Infant − Pediatric Electrostatic Filter HME
355U5427
Medtronic DAR™ Infant − Pediatric Electrostatic Filter HME 355U5427

Paediatric Ventilator Circuit 10-30kg

Self-inflating bag 500mL (Paediatric 4-25kg)

15mL dead space or smaller bi-flow viral filter (examples below)

MEDISIZE HYGROVENT CHILD HME/F
Straight or angled
Medtronic DAR™ Infant - Pediatric Electrostatic Filter HME Small
355U5430 (available with removable elbow)

Older Child/Adult >30kg

Self-inflating bag 1500mL (Adult >25kg)

50mL dead space or smaller bi-flow viral filter (examples below)

PALL Ultipor® 25 Filter
(Filter only, not HME)
KOALA Adult HME/Filter
KOALA Adult HME/Filter
MEDISIZE Barr-vent S
(Filter only, not HME)
Code 300 400 000
Medtronic DAR™ Adult − Pediatric
Electrostatic Filter HME (Small)
352U5877

Document information

Developed by

NSW Health: Paediatric COVID-19 Respiratory Working Party.

Consultation

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning , NSW Ministry of Health.

Reviewed by

Matt O’Meara, Chief Paediatrician.

For use by

NSW Health staff who provide care to infants, children and young people in a clinical setting.


Current as at: Sunday 29 November 2020
Contact page owner: Health Protection NSW