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In the US, critical care capacity was limited even before the COVID‐19 pandemic with over one‐third of patients having to wait 6 hours or more for transfer to an ICU.Ī number of non‐invasive options exist to support COVID‐19 patients with mild or moderate respiratory distress and may reduce the numbers of patients requiring intubation, mechanical ventilation, and ICU admission in some severely ill patients. In Italy, the number of critically ill COVID‐19 cases has exceeded the intensive care unit (ICU) capacity of affected regions, and in NYC, critical illness from COVID‐19 has already far exceeded existing ICU capacity. The high level of contagion combined with the lack of immunity to this virus in the population has resulted in an overwhelming number of severe or critical cases. The mode of spread and transmissibility is via respiratory droplets. The case fatality rate is extremely age dependent with an increase from <0.6% to 2.2% at age 60 and increasing to over 9.3% at age 80. The COVID‐19 pandemic has several features that are straining healthcare systems. This disease is presently known as COVID‐19. Despite massive efforts to contain viral transmission, a worldwide epidemic has developed from this virus. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi‐organ failure, or acute respiratory distress syndrome (ARDS).Ī novel clinical syndrome caused by a previously unknown coronavirus, SARS‐Cov‐2, was first identified in Wuhan (China) in December 2019. If used, measures special precautions should be used reduce aerosol formation. Non‐invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Be attentive to aerosol generation and the use of personal protective equipment. Maintain awareness of the aerosol‐generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks.
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(2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Consider metered dose inhaler alternatives. Summary recommendations include: (1) Avoid nebulized therapies. This is a clinical review of these options and their applicability in adult COVID‐19 patients. A number of non‐invasive options exist to avert mechanical ventilation and ICU admission. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. The COVID‐19 pandemic is creating unique strains on the healthcare system.