Abstract
Acute respiratory failure frequently occurs in severe COVID-19 and requires ventilator support. However, during the first wave of the pandemic, conventional resources for critically ill patients were insufficient in many centers. Therefore, an alternative strategy based on the use of non-invasive respiratory support (NIRS), and especially continuous positive airway pressure (CPAP), have been massively employed, either as a definitive therapy or as a bridge for orotracheal intubation. The results of this strategy have been excellent. If patients are carefully selected and monitored and NIRS is managed by an expert team in an appropriate environment, the vast majority of patients survive, avoiding intubation in most cases, and even decreasing the possibility of a self-inflicted lung injury (SILI). Moreover, there is evidence that with these techniques the risk of aerosolization is low. Nowadays, CPAP is considered the best option for most patients, with BiPAP being especially recommended in those with previous thoracic diseases or chronic hypercapnia. We conclude that NIRS techniques can be used in the initial care of most patients with severe respiratory failure from COVID-19 pneumonia and/or thromboembolism. To achieve the best results, intermediate care units, where specialized respiratory support can be provided, are the most appropriate framework.
Highlights
Since the pandemic was declared in March 2020, severe acute respiratory syndrome due to coronavirus type 2 (SARS-CoV-2) infection has been a critical global health problem
Severe COVID-19 caused by bilateral involvement of the lung parenchyma can be seriously aggravated in many cases by the coexistence of pulmonary thromboembolism, further worsening respiratory failure [5,6]
Based on initial published evidence [7,8,9], and the fact that many of these patients initially presented elevated spontaneous inspiratory drive with relatively large tidal volumes, and in trying to decrease the possibility of a self-inflicted lung injury (SILI) we decided to manage them in semicritical and even conventional COVID-19 units, initiating non-invasive respiratory support (NIRS) with continuous positive airway pressure (CPAP), two-level positive airway pressure (BiPAP), or high flow through nasal cannula (HFNC) as the initial approach for severe cases
Summary
Since the pandemic was declared in March 2020, severe acute respiratory syndrome due to coronavirus type 2 (SARS-CoV-2) infection has been a critical global health problem. Most cases are considered as a mild disease but nearly 14% require hospitalization, mostly for severe bilateral ‘pneumonia’ with oxygen requirements, and 5% need critical care and invasive mechanical ventilation [3]. Patients with SARS-CoV-2 pneumonia may develop severe Acute Respiratory Distress Syndrome (ARDS), as defined by Berlin criteria, during the clinical course of the disease [4].
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