28 tung Recruitment Lung recruitment improves the heterogeneous distribution of lesions in patients with ARDS. However, it may result in severe respitatory and circulatory complications and therefore, the lung recruitment manewer sot routinely commended. The assessment flung exoandatitty sould be performed prior tothe application, (2) Prone Position ventlation Most ertcaly il patents with COWD-19 respond well 9 prone ventilation, with 2 rapid Improvement of cxygenation and lung mechanics. rone ventilation is recommended a5 2 routine strategy for patients with Pa0,/FIO, < 150 mmia or with obvious Imaging manifestations without containdcations. Time course recommended for prone vention is more than 16 nours each time. The prone ventlation can be ceased ance P30,/F, i greater than 150 mmHg for more than 4 hauts in the supine position, Prone ventation while awake may be attempted for patents who have not been Incubated or have no obvious respiatary astess but wth impaled oxygenation or have consolidation in gravity-dependent lung zones on lng images. Procedures for at east 4 hours each time is recommended. Prone postion can be considered several times per ay depending onthe eects and tolerance (@) Prevention of Requrjtation and Aspiration lastrc esidval volume and gastoinestinal function should be routinely evaluated, ‘appropriate enteral nutition fe cecommended to be gen az earler at possile. Nasoinestinal feeding and continuous nasogastric decompression are recommended, Enteral nutition should be suspended and aspiration with $0 mL syringe be done belore ‘transfer, no contraindication exists, 2 30° sem-siting postion is recommended. (6) Fluid tanagement Excessive fluid butden worsens hypoxemia In COVID-19 patients. To reduce pulmonary feudation and imarove oxygenation, the amount of fuid should be stcty conttlled while ensuring the patent's perfusion. (6) strategies 0 Proven ventator-Assoclated Preumonia (VAP) ar bundled strategies should be strictly implemented © select appropriate ype of endotracheal tube; (© Use a endotracneal tube with sub otic suction (once every 2hours, aenirated with 20 rm empty syringe each sme; {@ Place the endotracheal tube atthe right postion and correct depth, fx property and void puling: