Respiratory management of pediatrics in the context of COVID-19
Patients requiring respiratory support due to COVID-19 illness will have a high viral load, and they pose a potential infection risk to healthcare professionals and other patients. All patients with confirmed or suspected COVID-19 illness must be managed with appropriate isolation and personal protective equipment (PPE) precautions. Refer to your hospital policy or the WHO guidelines.
The WHO suggests that, due to the uncertainty around the potential for aerosolization, nasal high flow (NHF) and noninvasive ventilation (NIV), including bubble CPAP, should be used with airborne precautions.
Nasal high flow
The WHO guidelines suggest commencing oxygen therapy with nasal cannula or prongs is the preferred oxygen therapy-delivery method for young children as they may be better tolerated, and NHF may be considered in select patients with hypoxemic respiratory failure. All patients treated with NHF should be closely monitored for clinical deterioration.
For institutions considering reducing the flow rates delivered via NHF during this pandemic, please be aware that this may negatively impact therapy effectiveness, and currently there is no evidence to suggest this mitigates risks to healthcare personnel. Appropriate isolation and airborne PPE precautions are still recommended (irrespective of flow rate) and, once in place, we suggest following evidence-based flow rates to maximize therapy effectiveness.
For data on aerosol dispersion, please visit Nasal High Flow Therapy COVID-19 Information.
The WHO guidelines note that in situations where mechanical ventilation might not be available, bubble nasal CPAP may be used for patients with severe hypoxemia and may be more readily available in resource-limited settings.
For institutions where bubble CPAP is the current standard of care for newborn infants requiring respiratory support (for non-COVID-19 reasons), there are currently no recommendations to change clinical practice for the majority of neonatal patients.
For information about heated humidification for healthcare professionals managing COVID-19 patients, please visit Heated Humidification for Healthcare Professionals Managing COVID-19 Patients.
Other useful resources and guidelines