COVID-19 and acute hypoxemic respiratory failure

For adults with COVID-19 and acute hypoxemic respiratory failure despite conventional oxygen therapy, the Panel recommends high-flow nasal cannula (HFNC) oxygen over noninvasive positive pressure ventilation (NIPPV).

In the absence of an indication for endotracheal intubation, the Panel recommends a closely monitored trial of NIPPV for adults with COVID-19 and acute hypoxemic respiratory failure for whom HFNC is not available.

For adults with COVID-19 who are receiving supplemental oxygen, the Panel recommends close monitoring for worsening respiratory status and that intubation, if it becomes necessary, be performed by an experienced practitioner in a controlled setting .

For patients with persistent hypoxemia despite increasing supplemental oxygen requirements in whom endotracheal intubation is not otherwise indicated, the Panel recommends considering a trial of awake prone positioning to improve oxygenation.

The Panel recommends against using awake prone positioning as a rescue therapy for refractory hypoxemia to avoid intubation in patients who otherwise require intubation and mechanical ventilation .

For mechanically ventilated adults with COVID-19 and acute respiratory distress syndrome (ARDS), the Panel recommends using low tidal volume (VT) ventilation (VT 4–8 mL/kg of predicted body weight) over higher tidal volumes (VT >8 mL/kg).

For mechanically ventilated adults with COVID-19 and refractory hypoxemia despite optimized ventilation, the Panel recommends prone ventilation for 12 to 16 hours per day over no prone ventilation. For mechanically ventilated adults with COVID-19, severe ARDS, and hypoxemia despite optimized ventilation and other rescue strategies, the Panel recommends using an inhaled pulmonary vasodilator as a rescue therapy; if no rapid improvement in oxygenation is observed, the treatment should be tapered off .

There are insufficient data to recommend either for or against the routine use of extracorporeal membrane oxygenation (ECMO) for patients with COVID-19 and refractory hypoxemia.

https://www.alliedacademies.org/special-issue/intensive-and-critical-care-management-of-novel-corona-virus.html

Best regards

Senior Journal Coordinator

Zoe Kemp

Journal of Intensive and critical care Nursing