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Reminder of important clinical lesson
Case report
Trimming the need for invasive ventilation: pragmatic critical care during the COVID-19 pandemic
  1. Connor P Oates1,
  2. Sarah A Goldman2,
  3. Gennaro Giustino3 and
  4. Martin E Goldman3
  1. 1Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  2. 2Albert Einstein College of Medicine, Bronx, New York, USA
  3. 3Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Connor P Oates; connor.oates{at}mountsinai.org

Abstract

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.

  • mechanical ventilation
  • CPAP
  • adult intensive care
  • mechanical ventilation

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-237597

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    Footnotes

    • Contributors CPO, SAG, GG and MEG each contributed to the care of the patient in this case as well as the conception, design and drafting of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.