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. 2020 Mar 29;57(4):335–342. doi: 10.1007/s13312-020-1786-x

Novel Coronavirus 2019 (2019-nCoV) Infection: Part II - Respiratory Support in the Pediatric Intensive Care Unit in Resource-limited Settings

Manu Sundaram 1, Namita Ravikumar 2, Arun Bansal 2,8,✉, Karthi Nallasamy 2, G V Basavaraja 3, Rakesh Lodha 4, Dhiren Gupta 5, Marti Pons Odena 6, Ashwath Ram 7, Muralidharan Jayashree 2; Intensive Care Chapter of Indian Academy of Pediatrics2
PMCID: PMC7182733  PMID: 32238613

Abstract

The 2019-novel coronavirus predominantly affects the respiratory system with manifestations ranging from upper respiratory symptoms to full blown acute respiratory distress syndrome (ARDS). It is important to recognize the risk factors, categorize severity and provide early treatment. Use of high flow devices and non-invasive ventilation has been discouraged due to high chances of aerosol generation. Early intubation and mechanical ventilation areessential to prevent complications and worsening, especially in resource-limited settings with very few centers having expertise to manage critical cases. Hydrophobic viral filter in the ventilator circuit minimizes chances of transmission of virus. Strategies to manage ARDS in COVID-19 include low tidal volume ventilation with liberal sedation-analgesia. At the same time, prevention of transmission of the virus to healthcare workers is extremely important in the intensive care setting dealing with severe cases and requiring procedures generating aerosol. We, herein, provide guidance on non-invasive respiratory support, intubation and management of ARDS in a child with COVID-19.

Keywords: 2019- nCoV, Aerosol generation, ARDS, Management, Pandemic, SARI

Contributors: MS, NR, AB, KN: substantial contribution to the conception and design of the work, anddrafting the work; GVB, RL, DG, MPO, ARRN, MJ: substantial contributions to the acquisition and interpretation of data for the work,and revising it critically for important intellectual content.All authors gave final approval of the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding: None

Competing interests: None stated.

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Articles from Indian Pediatrics are provided here courtesy of Nature Publishing Group

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