Non-invasive respiratory support in the treatment of acute hypoxemic respiratory failure secondary to CoViD-19 related pneumonia

Abstract

In the last 11 months, the SARS-CoV-2 pandemic has overwhelmed and disrupted the whole world in health, social and economic terms. We are progressively learning more and more about the epidemiological and clinical features that distinguish CoViD-19 from any previous experience in the emergency and critical care setting. Experiences are multiplying with regard to the use of non-invasive respiratory support techniques in the context of acute hypoxemic respiratory failure secondary to CoViD-19-related pneumonia. Doubts still far outweigh certainties, but a growing series of mostly monocentric and retrospective studies are becoming available as concrete decision-making and operational support for healthcare workers. In this review the available studies and experiences about non-invasive respiratory support in the treatment of Covid-19 related respiratory failure, mainly coming from outside the ICU setting, will be discussed.

Keywords: Acute hypoxemic respiratory failure; Covid-19 pneumonia; High-flow nasal cannulae; Non-invasive respiratory support; non-invasive ventilation.

Figure 1

Suggestion for an algorithm to be adopted in a protocolized approach to the patient with Covid-19 related respiratory failure. In the absence of solid evidence on the management of these patients, this was the alogorhythm adopted in the center of one of the authors of this article (PG). Legenda: SpO2: Saturation of arterial blood with oxygen as measured by pulse-oxymetry; FiO2: Fractional concentration of inspired oxygen; Conventional oxygen therapy devices: nasal cannuae, venture mask, non-rebreathing mask; HFNC: high flow nasal cannulae; CPAP: continuous positive airway pressure; PEEP: positive end expiratory pressure.