New WHO recommendations on respiratory support for severe and critically-ill COVID-19 patients


WHO has issued a fourth update to its living guidelines on COVID-19 clinical management. 

For hospitalized COVID-19 patients with acute respiratory failure but who are not yet at the stage where they need to be intubated, WHO suggests the use of the following three devices over standard oxygen therapy: high-flow nasal oxygen (HFNO); continuous positive airway pressure (CPAP); and non-invasive ventilation (NIV), also referred to as bilevel positive airway pressure (BiPAP).

Clinicians can choose between these devices. The available evidence was not strong enough to recommend one device over the other.

These devices are noninvasive so there is no need to place a tube in the patient’s airway. They provide respiratory support through their ability to provide higher oxygen flows, positive pressure or a combination of both.

Evidence shows that their use may reduce the need for invasive mechanical ventilation and the risk of dying when compared to standard oxygen therapy. Their use may also reduce the length of stay in the hospital and ICU.

These devices are not new; they have been used to treat acute respiratory failure from COVID-19 and other diseases, especially in high-resource settings. However, systematic data on their effectiveness in COVID-19 patients is starting to come in now, which triggered WHO’s guideline update.

The recommendation is based on five randomized controlled trials specific to COVID-19. The guideline development group, the body of experts which formulated the recommendation, looked at evidence from COVID-19 patients as well as other patients who have experienced acute respiratory distress syndrome.