top of page

Mwandishi:

Mhariri:

Imeboreshwa:

ULY CLINIC

ULY CLINIC

20 Februari 2026, 04:36:31

Respiratory management COVID-19

Respiratory management COVID-19
Respiratory management COVID-19
Respiratory management COVID-19
Respiratory management COVID-19

Hypoxaemia is the most life-threatening complication of COVID-19. The cornerstone of treatment is timely oxygen therapy and escalation of respiratory support to prevent progression to Acute Respiratory Distress Syndrome.


Oxygen Saturation Targets

Population

Target SpO₂

Non-pregnant adults

≥ 90%

Pregnant patients

≥ 92%

Children (resuscitation/emergency signs)

≥ 94%

Children (stable)

≥ 92%

Oxygen should be administered immediately when saturation is below target.

Principles of Oxygen Therapy

  • Oxygen is the single most effective supportive intervention

  • Titrate up or down according to response

  • Escalate early if no improvement

  • Continuous monitoring required


1. OXYGENATION AND VENTILATION METHODS

NON-INVASIVE OXYGENATION

A. LOW FLOW NASAL CANNULA


Indication

Mild hypoxemia SpO₂ 90–94%


Delivery Characteristics

Parameter

Value

Flow rate

1–6 L/min

FiO₂

22–45%

Limitation

Nasal irritation >4 L/min


Oxygen Sources

  • Oxygen concentrator

  • Oxygen cylinder

  • Central oxygen plant


Clinical Notes

  • First-line therapy

  • Requires frequent reassessment

  • Escalate if saturation not achieved


B. SIMPLE FACE MASK


Indication

Moderate hypoxemia SpO₂ < 90%


Delivery Characteristics

Parameter

Value

Flow

6–10 L/min

FiO₂

40–60%

Flow <5 L/min risks CO₂ retention

Clinical Notes

  • Intermediate oxygen delivery

  • Use respiratory rate + clinical judgement


C. NON-REBREATHER MASK (NRM)


Indication

Severe hypoxemia


Delivery Characteristics

Parameter

Value

Flow

10–15 L/min

FiO₂

85–95%


Clinical Notes

  • Rapidly improves oxygenation

  • Preferred before CPAP in many COVID patients


D. CPAP (Continuous Positive Airway Pressure)


Indication

  • Persistent hypoxemia

  • Pulmonary edema

  • Early respiratory failure


Mechanism

Provides positive pressure without intubation


Characteristics

  • Adjustable FiO₂

  • High-flow oxygen

  • Aerosol-generating → N95 required


Clinical Notes

  • Monitor closely

  • Escalate if fatigue or worsening hypoxia


E. BAG-VALVE-MASK VENTILATION (AMBU BAG)


Indication

  • Apnea

  • Agonal breathing

  • Severe respiratory failure


Characteristics

Parameter

Value

FiO₂

Up to 100%

Ventilation

Positive pressure


Clinical Notes

  • Temporary resuscitation measure

  • Prepare for intubation


F. HIGH FLOW NASAL OXYGEN (HFNO)


Indication

Failure of standard oxygen therapy


Characteristics

Parameter

Value

Flow

Up to 60 L/min

FiO₂

Up to 100%

Added effect

Mild positive pressure


Advantages

  • Better tolerated than NIV

  • Can be used outside ICU

  • Compatible with awake proning


INVASIVE OXYGENATION

MECHANICAL VENTILATION


Indications

  • Persistent hypoxia

  • Respiratory fatigue

  • Altered consciousness

  • Hemodynamic instability


Ventilation Targets

Parameter

Target

SpO₂

> 90%

Tidal volume

4–8 mL/kg

Plateau pressure

<30 cmH₂O


2. PRONE POSITIONING


Awake Proning

Beneficial in conscious hypoxemic patients


Mechanism

Improves ventilation-perfusion matching


Effects

  • Improves oxygenation

  • Delays intubation

  • Reduces mortality in moderate disease


3. RECOGNIZING SEVERE HYPOXEMIC RESPIRATORY FAILURE

Occurs when oxygen therapy fails.


Diagnostic Criteria

Parameter

Value

SpO₂

<90%

PaO₂

<60 mmHg

Oxygen need

>10 L/min via reservoir mask

Clinical

Increased work of breathing


Pathophysiology

  • Intrapulmonary shunting

  • V/Q mismatch

  • Diffuse alveolar damage


Escalation Strategy

Stepwise progression

  1. Nasal cannula

  2. Face mask

  3. Non-rebreather mask

  4. HFNO / CPAP / NIV

  5. Intubation + ventilation

Do not delay intubation if deterioration occurs.

Monitoring Requirements

Patients on HFNO/CPAP/NIV must be:

  • Closely observed

  • Managed by trained staff

  • In area capable of intubation


CLINICAL WARNING

Delaying intubation in worsening respiratory distress increases mortality.


Key Take-Home Principles

  • Oxygen early

  • Escalate quickly

  • Prone positioning helps

  • Monitor continuously

  • Intubate without delay when failing support


References

  1. Ministry of Health, Community Development, Gender, Elderly and Children (United Republic of Tanzania). Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. March 2021.

  2. World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected. WHO; 2020.

  3. World Health Organization. Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed. WHO Interim Guidance; 2020.

  4. World Health Organization. Coronavirus disease (COVID-19) Situation Report – 46. WHO; 2020.

  5. Del Rio C, Malani PN. 2019 Novel Coronavirus—Important Information for Clinicians. JAMA. 2020;323(11):1039-1040.

  6. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-1720.

  7. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of COVID-19 pneumonia in Wuhan, China. Lancet. 2020;395(10223):507-513.

  8. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China. Lancet. 2020;395:1054-1062.

  9. Zhao D, Yao F, Wang L, Zheng L, Gao Y, Ye J, et al. A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clin Infect Dis. 2020.

  10. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest Radiographic and CT Findings of COVID-19: Analysis of Nine Patients Treated in Korea. Korean J Radiol. 2020;21(4):494-500.

  11. Peng QY, Wang XT, Zhang LN. Findings of lung ultrasonography of COVID-19 pneumonia. Intensive Care Med. 2020.

  12. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 compared with SARS-CoV-1. N Engl J Med. 2020;382:1564-1567.

  13. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign Guidelines on the Management of Critically Ill Adults with COVID-19. Crit Care Med. 2020.

  14. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810.

  15. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA. 2012;307(23):2526-2533.

  16. Australian and New Zealand Intensive Care Society (ANZICS). COVID-19 Guidelines. Melbourne; 2020.

  17. World Confederation for Physical Therapy. Physiotherapy management for COVID-19 (Version 1.0). 2020.

  18. Queensland Health Clinical Excellence Division. COVID-19 Action Plan: Statewide General Medicine Clinical Network. 2020.


Imeandikwa:

24 Machi 2021, 15:04:18

bottom of page