COVID-19: How to Use a Jet Nebulizer for Drug Administration in Ventilated Patients without Putting the Healthcare Workers at Risk.

Dear Editor, A jet nebulizer is frequently used in ventilated patients to administer inhalations with bronchodilators and hypertonic saline. In ventilated COVID-19 patients, this can be beneficial to reduce airway blockage with viscous secretions and to decrease the need for bronchoscopy due to airway obstruction. However, the use of a nebulizer requires frequent disconnections of the ventilator circuit. In ventilated COVID-19 patients, this action can greatly increase the risk of airborne infection for healthcare workers through aerosol formation. The SARS-CoV-2 virus can remain viable and infectious in aerosols for hours [1]. It has been recommended that nebulization of medications should be avoided in ventilated COVID-19 patients to reduce the risk of infection for healthcare workers [2]. Usually, the use of a nebulizer requires disconnection of the heat and moisture exchanger (HME) filter (located between the endotracheal tube and the ventilator circuit) and the nebulizer itself for each inhalation (Fig. 1, showing standard configuration). We propose using a one-way valve (BTS1241A; WILAmed GmbH, Kammerstein, Germany) in the nebulizer T-piece (Fig. 2), which will enable disconnection of the nebulizer cup for medication loading Received: April 30, 2020 Accepted: May 22, 2020 Published online: June 2, 2020