Respiratory Treatments for COVID-19

The virus is spread through respiratory droplets. Any treatment or intervention resulting in
increased aerosolization of respiratory secretions is to be avoided as much as possible.
Oxygen Supplementation:

• Low-flow (regular) nasal cannula, all face masks (e.g., 100% non-rebreather, venti-
mask), high-flow nasal cannula (HFNC), and non-invasive positive pressure
ventilation (NIPPV; e.g., BIPAP, CPAP) can all be used
• Any use of HFNC or NIPPV must occur in a negative pressure room (ie, patients cannot
be transported on HFNC or NIPPV)
• Use of HFNC or NIPPV (other than for known sleep apnea) should prompt consultation
by the ICU triage team
Ventilation Support:
• When intubation is warranted:
o All efforts should be made to avoid ambubag
o See Protected Intubation SOP
Respiratory Treatments: (see Table below for guidance with dosing)
• Non-intubated patients
o Metered dose inhalers (MDIs) should be first line and are safe to administer
 use spacer if available
o Avoid nebulizers due to increased risk of aerosolization
 If used, must be in a negative pressure room

• Intubated patients
o All respiratory treatments require disconnection of the ventilator circuit and, thus,
increased risk of aerosolization
o Avoid MDIs and nebulizers if possible
 Literature* suggests albuterol for patients with acute respiratory distress
syndrome (ARDS) is:
• not helpful: no evidence reduces mortality and
• may be harmful: evidence reduces days free of organ failure &
need for ventilation
* Singh B et al, Resp Care. 2014 Feb;59(2):288-96; Wu R et al, World
J Emerg Med. 2015;6(3):165-71

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 o If decision made to use respiratory treatments:
 Metered dose inhalers (MDIs) should be first line (presumed safer to
administer)
• use spacer if available
• use 10 puffs for albuterol for each dose
 Use nebulizers only if unable to achieve desired effect with MDIs

Table. Usual Dosing for -Agonist MDIs and nebulizers

(modified from 2020 UpToDate, Inc.)

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