Respiratory Support for COVID-19 Patients

Nebulized 3% hypertonic saline solution, superficial nasal aspiration, and intravenous fluid therapy are used in our units, according to the latest guidelines and recent data from the literature (2 (link), 11 (link)–14 (link)). Intravenous fluid therapy is rapidly decreased when the clinical conditions are adequate to provide enteral feeding. Patients with persistent saturation levels below 92% and signs of respiratory distress (tachypnoea, chest retractions, etc.) or respiratory acidaemia on the venous blood gas analysis undergo high-flow nasal cannula (HFNC) as primary respiratory support: we provide a flow rate of 2 liters/minute per kilogram of body weight, starting with 4 liters/minute up to 10 liters/minute. We use nasal continuous positive airway pressure (nCPAP) or mechanical ventilation as rescue therapy for those patients with clinical deterioration. In the case of nCPAP, positive end-expiratory pressure (PEEP) is set between 5 and 7 cmH20.