Algorithm of oxygene therapy and noninvasive ventilation in COVID-19 patients


DOI: https://dx.doi.org/10.18565/therapy.2020.5.117-124

Babak S.L., Gorbunova M.V., Malyavin A.G.

A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia
The coronavirus disease (COVID-19) pandemic, caused by the highly contagious coronavirus SARS-CoV-2, continues to be an urgent global health problem, claiming thousands of lives every week. Unfortunately, despite numerous attempts to find pathogenetic drug therapy for the disease, the current survival rate of COVID-19 patients, especially those with severe forms of the disease, depends on their ability to maintain respiratory function and gas exchange. This clinical review focuses on respiratory support algorithms (oxygen therapy and non-invasive mechanical ventilation) and their applicability in adult COVID-19 patients.
Summary recommendations: 1) medical personnel should use a maximum of personal protective equipment (respirators/masks FFP3 N-95, eye protection, including face shield, goggles) taking into account the aerosol generating potential of devices for non-invasive respiratory support; 2) thermal helium-oxygen mixture (t-He/O2) and high-flow nasal oxygen therapy are preferred for COVID-19 patients with a high need of oxygen support; 3) non-invasive mechanical ventilation with positive pressure is the most justified therapy that reduces the high risks of nosocomial contamination from mechanical ventilation; 4) early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi-organ failure, or acute respiratory distress syndrome.
Keywords: SARS-CoV-2, coronavirus, COVID-19, thermal helium-oxygen mixture (t-He/O2), high-flow nasal oxygen therapy, non-invasive mechanical ventilation, CPAP therapy, BiPAP therapy
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Literature


  1. World Health Organization (2020). Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV2)infection is suspected: interim guidance, 28 January 2020. World Health Organization. Available at: https://apps.who.int/iris/handle/10665/330893 (date of access – 01.08.2020).

  2. CDC. Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/dialysis.html (date of access – 01.08.2020).

  3. Временные методические рекомендации – профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Версия 7 (03.06.2020). Министерство здравоохранения Российской Федерации. Электронное издание. Доступ: https://static-0.rosminzdrav.ru/system/attachments/attaches/000/050/584/original/03062020_МR_COVID-19_v7.pdf (дата обращения – 01.08.2020). [Temporary guidelines – prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 7 (03.06.2020). Ministry of Healthcare of the Russian Federation. Electronic edition. Available at: https://static-0.rosminzdrav.ru/system/attachments/attaches/000/050/584/original/03062020_МR_COVID-19_v7.pdf (date of access – 01.08.2020) (In Russ.)].

  4. NHS. Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected). 2020. Available at: https://www.england. nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/specialty-guide-NIV-respiratory-support-and-coronavirus-v3.pdf (date of access – 01.08.2020).

  5. Общероссийская общественная организация «Федерация анестезиологов и реаниматологов». Анестезиолого-реанимационное обеспечение пациентов с новой коронавирусной инфекцией COVID-19. Методические рекомендации. 2020. Доступ: http://www.far.org.ru/recommendation/covid-19 05052020.pdf (дата обращения – 01.08.2020). [All-Russian public organization «Federation of Anesthesiologists and Resuscitators». Anesthetic and resuscitation services for patients with the novel coronavirus infection COVID-19. Guidelines. 2020. Available at: http://www.far.org.ru/recommendation/covid-19 05052020.pdf (date of access – 01.08.2020).

  6. Zhang H., Penninger J.M., Li Y. et al. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Version 2. Intensive Care Med. 2020; 46(4): 586–90. doi: 10.1007/s00134-020-05985-9.

  7. Siddiqi H.K., Mehra M.R. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020; 39(5): 405–07. doi: 10.1016/j.healun.2020.03.012.

  8. Pfeifer M., Ewig S., Voshaar T. et al. Position paper for the State-of-the-art application of respiratory support in patients with COVID-19. Respiration. 2020; 99(6): 521–42. doi: 10.1159/000509104.

  9. Argyropoulos K.V., Serrano A., Hu J. et al. Association of initial viral load in severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) patients with outcome and symptoms. Am J Pathol. 2020: S0002–9440(20)30328-X. doi: 10.1016/j.ajpath.2020.07.001.

  10. Tang D., Comish P., Kang R. The hallmarks of COVID-19 disease. PLoS Pathog. 2020; 16(5): e1008536. doi: 10.1371/journal.ppat.1008536.

  11. Gattinoni L., Chiumello D., Caironi P. et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Version 2. Intensive Care Med. 2020; 46(6): 1099–102. doi: 10.1007/s00134-020-06033-2.

  12. Wunsch H. Mechanical ventilation in COVID-19: interpreting the current epidemiology. Am J Respir Crit Care Med. 2020; 202(1): 1–4. doi: 10.1164/rccm.202004-1385ED.

  13. Zareifopoulos N., Lagadinou M., Karela A. et al. Intubation and mechanical ventilation of patients with COVID-19: what should we tell them? Monaldi Arch Chest Dis. 2020; 90(1). doi: 10.4081/monaldi.2020.1296.

  14. Rational use of personal protective equipment for Coronavirus disease 2019 (COVID-19). World Health Organization. 2020. Available at: https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCov-IPCPPE_use-2020.1-eng.pdf (date of access – 01.08.2020).

  15. Письмо Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека от 11.04.2020 № 02/6673-2020-32 «О направлении рекомендаций по применению СИЗ для различных категорий граждан при рисках инфицирования COVID-19». [Letter from Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing dated 2020 April 11 No 02/6673-2020-32 «On the direction of recommendations on the use of personal protective equipment for various categories of citizens at risk of infection with COVID-19» (In Russ.)].

  16. Guan L., Zhou L., Zhang J. et al. More awareness is needed for severe acute respiratory syndrome coronavirus 2019 transmission through exhaled air during non-invasive respiratory support: experience from China. Eur Respir J. 2020; 55(3): 2000352. doi: 10.1183/13993003.00352-2020.

  17. Kumar Am., Kumar Ab., Kumar N. et al. Modified oxygen therapy device for prevention of aerosol dispersion in COVID-19 patients. J Clin Anesth. 2020; 65: 109884. doi: 10.1016/j.jclinane.2020.109884.

  18. Agarwal A., Basmaji J., Muttalib F. et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission. Can J Anaesth. 2020: 1–32. doi: 10.1007/s12630-020-01740-2.

  19. Winck J.C., Ambrosino N. COVID-19 pandemic and non-invasive respiratory management: Every Goliath needs a David. An evidence-based evaluation of problems. Pulmonology. 2020; 26(4): 213–20. doi: 10.1016/j.pulmoe.2020.04.013.

  20. Cinesi Gomez C., Penuelas Rodriguez O., Lujan Torne M.L. et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Rev Esp Anestesiol Reanim. 2020; 67(5): 261–70. doi: 10.1016/j.redar.2020.03.006.

  21. Lucchini A., Giani M., Isgro S. et al. The «helmet bundle» in COVID-19 patients undergoing non invasive ventilation. Intensive Crit Care Nurs. 2020; 58: 102859. doi: 10.1016/j.iccn.2020.102859.


About the Autors

Sergey L. Babak, MD, professor of the Department of phthisiology and pulmonology of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 107150, Moscow, 39/2 Losinoostrovskaya Str. E-mail: sergbabak@mail.ru
Marina V. Gorbunova, PhD, associate professor of the Department of phthisiology and pulmonology of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 107150, Moscow, 39/2 Losinoostrovskaya Str. E-mail: mgorb@mail.ru
Andrey G. Malyavin, MD, professor, professor of the Department of phthisiology and pulmonology of A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of Russia. Address: 107150, Moscow, 39/2 Losinoostrovskaya Str. E-mail: maliavin@mail.ru

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