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

Manel Luján, César Cinesi Gómez, Oscar Peñuelas Rodríguez, Carlos Ferrando Ortolá, Sarah Beatrice Heili Frades Zimmermann, José Manuel Carratalá Perales, Arantxa Mas, Javier Sayas Catalán, Olga María Mediano San Andrés, O. Roca, Javier García Fernández, Antonio González Varela, Gonzalo Sempere Montes, Gemma Rialp Cervera, Gonzalo Hernández, Teresa Millán Guilarte, Miguel Ferrer Monreal, Carlos Javier Egea Santaolalla

• 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.