- Using high-flow nasal oxygen for patients with moderately severe hypoxemia might reduce the need for intubation.
- For mechanically-ventilated patient:
- Tidal volume: 6mL/kg per predicted bodyweight
- Plateau airway pressure: Less than 30 cm H2O
- Respiratory rates: Increase to 35 bpm as needed
- In case of ventilator dyssynchrony, increased airway pressure and hypoxaemia, deep sedation should be used with neuromuscular blockade using cisatracurium.
3. Progression of hypoxemia with a PaO2:FiO2 ratio of less than 100–150 mm Hg:
- Positive end-expiratory pressure: Increase by 2-3 cm H2O every 15-30 minutes to achieve an oxygen saturation around 88-90%.
- Consider prone positioning.
- Recruitment manoeuvres are not recommended, but moderate pressures of 30 cm H2O for 20-30 seconds can be tried.
4.For persistent refractory hypoxaemia:
- Consider Inhaled NO
- Fluid management: Target a negative fluid balance of 0.5 to 1L per day in the absence of shock.
- Consider antibiotics to treat secondary bacterial infection.
- Consider high dose Vitamin C
- Do not used glucocorticoids
- ECMO should be considered using EOLIA trial criteria
This data comes from analysis of recommendations for the treatment of patients with ARDS published by Extracorporeal Life Support Organization. They studied how extracorporeal membrane oxygenation (ECMO) should be used for patients with Covid-19.
- Matthay, M. A., Aldrich, J. M., Gotts, J. E. (March 20, 2020). Treatment for severe acute respiratory distress syndrome from COVID-19. The Lancet Respiratory Medicine. https://doi.org/10.1016/S2213-2600(20)30127-2
- Griffiths M. J. D., McAuley D. F., Perkins G. D., et al ( May 24, 2019). Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respiratory Research. https://doi.org/10.1136/bmjresp-2019-000420