Algorithm of respiratory support for COVID-19 patients


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Abstract

The coronavirus disease (COVID-19) pandemic, caused by the highly contagious SARS-CoV-2 coronavirus, is still at its peak, causing thousands of deaths every week. The current survival rate of COVID-19 patients with severe course of disease depends entirely on the provision of effective therapy. Methods of respiratory support preventing the need for artificial lung ventilation (ALV) are now clinically available for patients with COVID-19. This clinical review focuses on respiratory support algorithms (oxygen therapy and CPAP) and their applicability in adult COVID-19 patients. Brief recommendations for performing respiratory support in this category of patients include the following provisions: 1) medical personnel should use a maximum of personal protective equipment (respirators/masks FFP3 N-95, eye protection [face shield, goggles]), taking into account the aerosol-generating potential of devices for non-invasive respiratory support; 2) emergency oxygen therapy is required for all patients with COVID-19 who have SpO2 <92% on room air (FiO2=21°%) or they have PaO2 <55 mmHg (<7.0 kPa); 3) thermal helium-oxygen mixture (t-He/O2) and high-flow nasal oxygen therapy (HFNOT) are preferred for COVID-19 patients with a high demand for oxygen support; 4) respiratory support in the mode of continuous positive airway pressure (CPAP) with a high oxygen flow is the most justified therapy that reduces the high risks of nosocomial contamination; 5) early intubation and artificial lung ventilation are reasonable and necessary for patients with progressive respiratory failure, with the development of multiple organ failure, acute respiratory distress syndrome.

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About the authors

S. L Babak

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

Email: seigbabak@mail.ru
Dr. Sci. (Med.), Professor at the Department of Phthisiology and Pulmonology, Faculty of General Medicine 39, build. 2, Losinoostrovskaya str., Moscow 107150, Russian Federation

M. V Gorbunova

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

A. G Malyavin

A.I. Yevdokimov Moscow State University of Medicine and Dentistry

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