General schema for respiratory support in patients with COVID-19

Low flow nasal cannula

 • Typically set at 1-6 liters/minute

High flow nasal cannula (with Iimitation in the flow rate)

CPAP

 • Titrate CPAP up as tolerated (in more severe hypoxemia might target ~15-18 cm)

 • Viral filter

 • N95 mask & aerosol precautions.

 • (Helmet interface possibly ideal)

Invasive Mechanical Ventilation

 • Target tidal volumes of ~6 cc/kg.

 • Permissive hypercapnia may be useful to allow for lung-protective settings.

 • May use conventional lung-protective ventilation strategies or APRV.

Prone positioning

 • Exact indication for prone ventilation is unclear.

• Proning is a front-line therapy for refractory hypoxemia, but it's unclear whether it is beneficial in all patients with PaO2/FiO2 ratio <150.

VV-ECMO

 • indicatons remain unclear.

 • Early discussion With ECMO center or team may be advisable.



Internet Book of Critical Care @iBookCC



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