Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient

• Manel Luján ^[1] ; César Cinesi Gómez ^[2] ; Oscar Peñuelas ^[3] ; Carlos Ferrando ^[3] ; Sarah Béatrice Heili Frades ^[3] ; José Manuel Carratalá Perales ^[10] ; Arantxa Mas ^[4] ; Javier Sayas Catalán ^[5] ; Olga Mediano ^[3] ; Oriol Roca ^[3] ; Javier García Fernández ^[11] ; Antonio González Varela ^[6] ; Gonzalo Sempere Montes ^[7] ; Gemma Rialp Cervera ^[12] ; Gonzalo Hernández ^[8] ; Teresa Millán ^[9] ; Miquel Ferrer Monreal ^[3] ; Carlos Egea Santaolalla ^[13]
  1. [1] Universitat Autònoma de Barcelona

     Universitat Autònoma de Barcelona

     Barcelona, España

     
  2. [2] Hospital General Universitario Reina Sofía

     Hospital General Universitario Reina Sofía

     Murcia, España

     
  3. [3] Instituto de Salud Carlos III

     Instituto de Salud Carlos III

     Madrid, España

     
  4. [4] Hospital de la Santa Creu i Sant Pau

     Hospital de la Santa Creu i Sant Pau

     Barcelona, España

     
  5. [5] Hospital Universitario 12 de Octubre

     Hospital Universitario 12 de Octubre

     Madrid, España

     
  6. [6] Hospital Universitario Central de Asturias

     Hospital Universitario Central de Asturias

     Oviedo, España

     
  7. [7] Hospital Universitario Doctor Peset

     Hospital Universitario Doctor Peset

     Valencia, España

     
  8. [8] Hospital Virgen de la Salud

     Hospital Virgen de la Salud

     Toledo, España

     
  9. [9] Hospital Universitario Son Espases

     Hospital Universitario Son Espases

     Palma de Mallorca, España

     
  10. [10] Servicio de Urgencias-Unidad de Corta Estancia, Hospital General Universitario, Alicante, Spain
  11. [11] Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
  12. [12] Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
  13. [13] Servicio de Neumologia, Hospital Universitario de Araba, Spain

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 60, Nº. 5, 2024, págs. 285-295
• Idioma: inglés
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• Resumen

  • Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation.

    Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered.

    While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.