Abstract：
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.
摘要：
COVID-19肺炎导致的急性呼吸衰竭通常需要全面的方法，包括非药物策略，如非侵入性支持(包括正压模式，高流量治疗或清醒的练习)除了氧气治疗之外，主要目标是避免气管插管。临床问题，如确定启动非侵入性支持的最佳时间，选择最合适的方式（不仅基于急性临床表现，还基于合并症），建立识别治疗失败的标准和在这种情况下遵循的策略（包括姑息治疗），或在出现改善时实施降级程序对于严重COVID-19病例的持续管理至关重要。组织问题，例如管理和监测严重COVID-19患者的最合适环境，或在存在气溶胶生成程序的情况下防止病毒传播给医护人员的保护措施，也应该考虑。虽然大流行期间的许多早期临床指南是基于以前的急性呼吸窘迫综合征的经验，从那以后，景观发生了变化。今天,我们有大量高质量的研究支持以证据为基础的建议来解决这些复杂的问题.这份文件,四个领先的科学学会(SEDAR，SEMES,SEMICYUC,SEPAR),借鉴该领域25名专家的经验，综合知识以解决相关的临床问题，并在面对严重COVID-19感染带来的挑战时改进患者护理方法。
