Diagnostics (Dec 2021)

Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation

  • Barbara Bonnesen,
  • Jens-Ulrik Stæhr Jensen,
  • Klaus Nielsen Jeschke,
  • Alexander G. Mathioudakis,
  • Alexandru Corlateanu,
  • Ejvind Frausing Hansen,
  • Ulla Møller Weinreich,
  • Ole Hilberg,
  • Pradeesh Sivapalan

DOI
https://doi.org/10.3390/diagnostics11122259
Journal volume & issue
Vol. 11, no. 12
p. 2259

Abstract

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Patients admitted to hospital with coronavirus disease 2019 (COVID-19) may develop acute respiratory failure (ARF) with compromised gas exchange. These patients require oxygen and possibly ventilatory support, which can be delivered via different devices. Initially, oxygen therapy will often be administered through a conventional binasal oxygen catheter or air-entrainment mask. However, when higher rates of oxygen flow are needed, patients are often stepped up to high-flow nasal cannula oxygen therapy (HFNC), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or invasive mechanical ventilation (IMV). BiPAP, CPAP, and HFNC may be beneficial alternatives to IMV for COVID-19-associated ARF. Current evidence suggests that when nasal catheter oxygen therapy is insufficient for adequate oxygenation of patients with COVID-19-associated ARF, CPAP should be provided for prolonged periods. Subsequent escalation to IMV may be implemented if necessary.

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