Table 3.
Specific respiratory interventions.
| Aerosol-generating procedures |
The following procedures create an airborne risk of transmission of COVID-19: • intubation/extubation • bronchoscopy • high-flow nasal oxygen use • non-invasive ventilation • tracheostomy • cardiopulmonary resuscitation prior to intubation12,22 Additional aerosol-generating procedures related to physiotherapy techniques are outlined in Box 3. |
| High-flow nasal oxygen |
This is a recommended therapy for hypoxia associated with COVID-19, as long as staff are wearing optimal airborne PPE.12 At flow rates 40 to 60 l/min, high-flow nasal oxygen does carry a small risk of aerosol generation. The risk of airborne transmission to staff is low when optimal PPE and other infection control precautions are being used.23 Negative pressure rooms are preferable for patients receiving high-flow nasal oxygen.12 Respiratory support via high-flow nasal oxygen should be restricted to patients in airborne isolation rooms only. Limiting the flow rate to no more than 30 l/min might reduce potential viral transmission. |
| Non-invasive ventilation |
Routine use is not recommended12 because current experience with COVID-19 hypoxic respiratory failure has a high associated failure rate. If used (eg, with a patient with chronic obstructive pulmonary disease or post-extubation), it must be provided with strict airborne PPE.12 |
| Oxygen therapy |
Treatment targets may vary depending on the presentation of the patient. • For patients presenting with severe respiratory distress, hypoxaemia or shock, SpO2 > 94% is targeted.23 • Once a patient is stable, the SpO2 target is > 90% in non-pregnant adults24 and 92 to 95% in pregnant patients.23 • In adults with COVID-19 and acute hypoxaemic respiratory failure, the SpO2 target should not be maintained > 96%.22 |
| Nebulisation | The use of nebulised agents (eg, salbutamol, saline) for the treatment of non-intubated patients with COVID-19 is not recommended because it increases the risk of aerosolisation and transmission of infection to healthcare workers in the immediate vicinity. Use of metered-dose inhalers or spacers is preferred where possible.12 If a nebuliser is required, liaise with local guidelines for directions to minimise aerosolisation (eg, use of a Pari Sprint with inline viral filter). Use of nebulisers, non-invasive ventilation, high-flow nasal oxygen and spirometry should be avoided and agreement to their use sought from senior medical staff.20 If deemed essential, airborne precautions should be used. |
COVID-19 = coronavirus disease 2019, FTE = full-time equivalent, HDU = high dependency unit, ICU = intensive care unit, PPE = personal protective equipment, SpO2 = oxyhaemoglobin saturation.