Paediatric viral filters and combined heat moisture exchange – Quick reference guide

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.

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.

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.

Type	Filter or HME maximum volume	Examples
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 (HMEF) 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		refer to: Procedural sedation in the ED QR code