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COVID-19 infection may present with mild, moderate or severe illness; the latter includes severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis and septic shock. Early recognition of suspected patients allows timely initiation of infection prevention and control measures (IPC). In the current situation most patients who need some kind of respiratory support are connected to invasive ventilation systems in the ICU and due to the flow of number of patients, ventilation systems are running out.
The current information suggests that, in the early stages of the severe forms of the disease, the majority of COVID-19 patients are suffering from severe hypoxia, and require rapid and efficient management of hypoxemia using Positive End Expiratory Pressure (PEEP), FiO2. Other underlying chronic illnesses must be treated accordingly, but again the effect of COVID-19 appears to be mostly hypoxemia.
Non-invasive respiratory (NIV) support plays an essential role in the treatment of COVID-19. While NIV won’t be an option for every patient with COVID-19 depending on the severity of their symptoms, it has the potential to help many patients in respiratory distress, while ensuring that invasive ventilation options are available for the most severe patterns of the diseases. Clinical need should determine the use of non-invasive ventilation (NIV) and high-flow nasal oxygen (HFNO), taking into account IPC considerations. CPAP can respond to oxygenation needs when lung lesions are not yet developed, but cannot be used in its current form due to the risk of virus spread.There are no grounds for an indiscriminate ban on the use of NIV. In general, invasive mechanical ventilation (IMV) is preferred over NIV mainly for IPC reasons. Likewise NIV is preferred over HFNO because of its lower risk of disease transmission and lower consumption of oxygen supplies.