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Vol. 60. Issue 5.
Pages 285-295 (May 2024)
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Vol. 60. Issue 5.
Pages 285-295 (May 2024)
SEPAR's Voice
Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient
Manel Lujána,b,
Corresponding author

Corresponding author.
, César Cinesi Gómezc, Oscar Peñuelasb,d, Carlos Ferrandob,e, Sarah Béatrice Heili-Fradesb,f, José Manuel Carratalá Peralesg, Arantxa Mash, Javier Sayas Cataláni, Olga Medianob,j, Oriol Rocab,k, Javier García Fernándezl, Antonio González Varelam, Gonzalo Sempere Montesn, Gemma Rialp Cerverao, Gonzalo Hernándezp, Teresa Millánq, Miquel Ferrer Monrealb,r, Carlos Egea Santaolallas
a Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
b CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
c Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
d Servicio de Medicina Intensiva Hospital Universitario de Getafe, Madrid, Spain
e Department of Anesthesia and Critical Care, Hospital Clínic, Institut D’investigació August Pi i Sunyer, Barcelona, Spain
f Hospital Universitario Fundación Jiménez Díaz Quirón Salud, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), CIBERES, REVA Network, Madrid, Spain
g Servicio de Urgencias-Unidad de Corta Estancia, Hospital General Universitario, Alicante, Spain
h Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
i Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain
j Sleep Unit, Pneumology Department. Hospital Universitario de Guadalajara, Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Universidad de Alcalá, Madrid, Spain
k Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí–I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
l Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
m Servicio Urgencias, Hospital Universitario Central de Asturias, Spain
n Unidad de Corta Estancia, Hospital Universitario Dr. Peset, Valencia, Spain
o Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
p Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
q Servicio de Medicina Intensiva Hospital Universitario Son Espases, Facultad de Medicina de las Islas Baleares, Spain
r UVIIR, Servei de Pneumologia, Institut de Respiratori, Clínic Barcelona, IDIBAPS. Universitat de Barcelona, Barcelona, Spain
s Servicio de Neumologia, Hospital Universitario de Araba, Spain
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Figures (3)
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Tables (5)
Table 1. Criteria for NIRS failure.
Table 2. Supportive strategies for skin protection and nutrition in COVID-19 patients.76–85
Table 3. Strategy for avoiding aerosol dispersion during endotracheal intubation.
Table 4. Groups at risk (hypoxemic ARF) in which NIV after extubation is recommended.102,104
Table 5. Summary of recommendations.
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Additional material (1)

Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation.

Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered.

While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.

Non invasive support
High flow therapy
Non invasive ventilation
Continuous positive airway pressure
Awake proning


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