Respiratory support for patients with COVID-19 infection
Authors: Silvio A Ñamendys-Silva
Journal: The Lancet Respiratory Medicine (2020)

As of Feb 27, 2020, coronavirus disease 2019 (COVID-19) has affected 47 countries and territories around the world.1WHOCoronavirus disease 2019 (COVID-19) situation report – 38. World Health Organization, GenevaFeb 27, 2020https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200227-sitrep-38-covid-19.pdf?sfvrsn=9f98940c_2Date accessed: February 27, 2020Google Scholar Xiaobo Yang and colleagues2Yang X Yu Y Xu J et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet Respir Med. 2020; (published online Feb 21.)https://doi.org/10.1016/S2213-2600(20)30079-5Summary Full Text Full Text PDF Scopus (6966) Google Scholar described 52 of 710 patients with confirmed COVID-19 admitted to an intensive care unit (ICU) in Wuhan, China. 29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%) of 29 and among those who required invasive mechanical ventilation was 19 (86%) of 22.2Yang X Yu Y Xu J et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet Respir Med. 2020; (published online Feb 21.)https://doi.org/10.1016/S2213-2600(20)30079-5Summary Full Text Full Text PDF Scopus (6966) Google Scholar Jonathan Chun-Hei Cheung and colleagues3Cheung J C-H Ho LT Cheng JV Cham EYK Lam KN Staff safety during emergency airway management for COVID-19 in Hong Kong.Lancet Respir Med. 2020; (published online Feb 24.)https://doi.org/10.1016/S2213-2600(20)30084-9Summary Full Text Full Text PDF PubMed Scopus (304) Google Scholar do not recommend use of a high-flow nasal cannula or non-invasive ventilation until the patient has viral clearance. Supporting the recommendation of the authors, I would like to add some points in relation to the use of high-flow nasal oxygen therapy and non-invasive ventilation in patients with COVID-19 infection: First, although exhaled air dispersion during high-flow nasal oxygen therapy and non-invasive ventilation via different interfaces is restricted, provided that there is a good mask interface fitting,4Hui DS Chow BK Lo T et al.Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks.Eur Respir J. 2019; 531802339Crossref PubMed Scopus (252) Google Scholar not all hospitals around the world have access to such interfaces or enough personal-protective equipment of sufficiently high quality (ie, considered fit-tested particulate respirators, N95 or equivalent, or higher level of protection) for aerosol-generating procedures, and several hospitals do not have a negative pressure isolation room. Of 1688 health-care workers who have become infected with COVID-19, five (0·3%) have died;5Novel Coronavirus Pneumonia Emergency Response Epidemiology TeamThe epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China.Zhonghua Liu Xing Bing Xue Za Zhi. 2020; 41: 145-151PubMed Google Scholar a sign of the vastly difficult working conditions for health-care workers. Second, the fundamental pathophysiology of severe viral pneumonia is acute respiratory distress syndrome (ARDS).2Yang X Yu Y Xu J et al.Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study.Lancet Respir Med. 2020; (published online Feb 21.)https://doi.org/10.1016/S2213-2600(20)30079-5Summary Full Text Full Text PDF Scopus (6966) Google Scholar Non-invasive ventilation is not recommended for patients with viral infections complicated by pneumonia because, although non-invasive ventilation temporarily improves oxygenation and reduces the work of breathing in these patients, this method does not necessarily change the natural disease course.6Namendys-Silva SA Hernández-Garay M Rivero-Sigarroa E Non-invasive ventilation for critically ill patients with pandemic H1N1 2009 influenza A virus infection.Crit Care. 2010; 14: 407Crossref PubMed Scopus (20) Google Scholar Finally, the application of non-invasive ventilation in patients with COVID-19 in the ICU is controversial. Considering the above factors, clinicians might not use non-invasive ventilation for critically ill patients with ARDS due to COVID-19 until further data from the COVID-19 epidemic are available. I declare no competing interests. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational studyThe mortality of critically ill patients with SARS-CoV-2 pneumonia is considerable. The survival time of the non-survivors is likely to be within 1–2 weeks after ICU admission. Older patients (>65 years) with comorbidities and ARDS are at increased risk of death. The severity of SARS-CoV-2 pneumonia poses great strain on critical care resources in hospitals, especially if they are not adequately staffed or resourced. Full-Text PDF Staff safety during emergency airway management for COVID-19 in Hong KongMedical professionals caring for patients with coronavirus disease 2019 (COVID-19) are at high risk of contracting the infection.1 Aerosol-generating procedures, such as non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), bag-mask ventilation, and intubation are of particularly high risk.2 We hereby describe the approach of our local intensive care unit (North District Hospital, Sheung Shui, Hong Kong) to managing the risks to health-care staff, while maintaining optimal and high-quality care. Full-Text PDF