Hypoxemia and tachypnea should not be the sole indications for intubation, but rather a complete clinical assessment including work of breathing, mental status and increasing PaCO2 and/or acidosis. Based on experience in NYC, patients who present early in the disease course with oxygen saturations in the 80’s, but who are otherwise clinically well and relatively asymptomatic, do not require intubation. There have been suggestions that these patients may benefit from prone positioning and HFNC (see below). The recommendation early in the COVID pandemic to strongly consider early intubation in all patients with oxygen saturations <90% despite non-invasive oxygenation may not be the best approach.
Improved drainage effect on respiratory secretions
Reduced lung compression
Consistently, most trials demonstrate improved oxygenation with ventilation in the prone position. One randomized trial and several meta-analyses also suggest a mortality benefit in those with severe ARDS. Trials have consistently shown that in most patients with ARDS (up to 70 percent), prone ventilation increases PaO2允许在氧合指数的降低2。谁表现出响应大多数患者这样做的第一个小时内，但超出了延迟的响应已被观察到。该PROSEVA审判和几个荟萃分析报告死亡率的好处从早期的，大剂量的重症患者ARDS俯卧位通气（由他们作为氧分压定义2：氧合指数2<150 mmHg). There is no evidence that prone ventilation prevents organ system dysfunction and reduces the intensive care unit (ICU) length of stay.
4。Transmission routes– Looks like pseudo-droplet spread in some manner. Also looks like “infected” can reduce spread by surgical mask—which justifies asymptomatic population wearing masks to protect infecting others. We don’t know if it will reduce acquisition. The difference between public masking to reduce spread vs. reducing acquisition is an important one. Probably what motivates most people is not getting infected, but we don’t have great evidence masking will do that, and it probably de-emphasizes hand hygiene.
5。COVID-19疗法– we are still lacking helpful information on pretty well anything. More and more case series with different treatments. None of them game-changing yet. Paper out of Australia suggests that伊维菌素反对COVID-19理论上的有效 - 陪审团仍然是完全脱离的那一个，太。阅读完整的纸抗病毒研究标题为：美国食品药物管理局批准的药物伊维菌素抑制SARS-CoV的-2在体外的复制：HTTPS：//万维网。sciencedirect。com/科学/文章/PII /S0166354220302011
3。O2 saturation >94% on RA
4. RR <20，HR <110，BP在基线或预期年龄/性别
5。Does not appear clinically decompensated
6. Walk test: can walk 30 meters with <10% drop in O2 saturation (even if CXR or POCUS +ive)
HCW conducting this procedure should do so in a separate/isolation room, be well trained in the procedure, wear droplet precaution PPE, and request the patients to cover their mouth with a medical mask or tissue during NP swab.