Author: Whittle, Jessica S.; Pavlov, Ivan; Sacchetti, Alfred D.; Atwood, Charles; Rosenberg, Mark S.
Title: Respiratory support for adult patients with COVIDâ€19 Cord-id: 1myh24ab Document date: 2020_4_13
ID: 1myh24ab
Snippet: The COVIDâ€19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of nonâ€invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVIDâ€19 patients. Summary recommendations include: (1) Avoid ne
Document: The COVIDâ€19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of nonâ€invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVIDâ€19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosolâ€generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use nonâ€rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Nonâ€invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multiâ€organ failure, or acute respiratory distress syndrome (ARDS).
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