Respiratory critical care in COVID-19

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Pureepat Arttawejkul


Among patients with coronavirus disease 2019 (COVID-19), up to 5% require intensive care
unit (ICU) admission. Profound hypoxemic respiratory failure from acute respiratory distress
syndrome (ARDS) is the dominant finding. Targeting a peripheral oxygen saturation between 90
and 96 percent is ideal. The use of high-flow oxygen via nasal cannulae (HFNC) and noninvasive
ventilation (NIV) is controversial based on infection control concerns and the frequent need
for mechanical ventilation despite these measures. Intubation should not be delayed until
the patient acutely decompensates since this is potentially harmful to both the patient and
healthcare workers. Aerosol generating procedures are high risk procedure for aerosol dispersion
and attention should be paid to donning full personal protective equipment (PPE) with airborne
precautions. Patients who are mechanically ventilated should received standard care per ARDS
protocol with high caution regarding prevention of aerosol dispersion


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