key: cord-260105-ckh8jp9e
authors: Ñamendys-Silva, Silvio A
title: Respiratory support for patients with COVID-19 infection
date: 2020-04-30
journal: The Lancet Respiratory Medicine
DOI: 10.1016/s2213-2600(20)30110-7
sha: 
doc_id: 260105
cord_uid: ckh8jp9e

nan

do not recommend use of a high-flow nasal cannula or noninvasive 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, 4 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; 5 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). 2 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. 6 Finally, the application of noninvasive 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. 

Geneva: World Health Organization

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study

Staff safety during emergency airway management for COVID-19 in Hong Kong

Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks

Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China

Non-invasive ventilation for critically ill patients with pandemic H1N1 2009 influenza A virus infection