Guidance for the role and use of non-invasive respiratory support in adult patients with coronavirus (confirmed or suspected)

Summary

This document should be used to guide clinicians on the appropriate use of continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), here referring to bilevel positive airway pressure (BiPAP) and high flow nasal oxygen (HFNO, such as OptiflowTM) in patients with confirmed or suspected COVID-19. Published evidence, clinical guidelines and personal communications with colleagues in China and Italy have informed this document.

The guidance is not designed to be prescriptive but to provide a useful aid to use alongside clinical judgement. It can be adjusted to suit individual clinical environments. Decisions relating to the escalation of ventilatory support (whether as a trial of treatment, as a ceiling of care, or as a possible bridge to ongoing invasive ventilation) need to be made early and by experienced clinical decision-makers.