27 andbok of COMD-19 Prevention an Heatment (4) Coniroloxygen nerapy P20. /F0, i 2 sensitive and accurate Indicator of oxygenation function. The stably and ‘monitarablity af Fo, are very important fr patients wit disease progression and PaO. IO, below 300 mmr, Contolled oxygen therapy isthe preferred weatment. Highflow nasal cannula (HFNC) oxygen therapy is recommended for patients with the following conditions: Sp, «98%; PaO, F10. = 300 mmiig (1 mmiig = 0.133 KPa) respiratory rate 25 times per min a bed; of remarkable progression on X-ray imaging. Patients should Wear 3 surgieal mask during HNC treatment. Tne airflow of HFNC oxygen therany should Start ata (ow (evel and gradually increased up to 40-60 L/min when Pa0,/FI0, fs between 200-300 mmilg so that patents do not fee obvious chest tighiness and shortness of areath, ‘hn ina How of atleast 60 L/min should be given Immediate) Tor patents with OBvious Fespiatory astess Tracheal intubation for patents is dependent on alsease progression, systemic status and Complication of patients for those with stable skuatian aut witn alow oxygenation index {100 mig), Thus, detailed evaluations ofthe clinical condition of patients very important before decision making. Tracheal intubation should be performed as eary as possible for patients ith an oxygenation indexiess than 150 mmg, worsening symtoms of respiratory Gisvess ot multinle organ dysfunction within 1-2 hours after high-flow (60 L/min) 3nd highseancentration (= 608) HENC oxygen therapy. Older patients (> 60 years old) with more complications or PaOu/FIO: tess than 200 mmHg 3.2 Mechanical Ventilation (1) Noninvasive ventilation (wv) 'Nlvisnotstronaly recommended in COVID-19 patients who fal HENC treatment. Some severe patients progress to ARDS rapidly. Excessive inflation pressute may cause gastric astension Sndintoterance which contribute to aspration and worsen lung injury. Asrort-term (lessthan 2hours use of niVcan be closely manttored Ifthe patent has acute leftheat fare, chronic ‘bstuctive pulmonary dsease ori Immunocompramised. intubation should be performed 435 early as possible if improvement of respiratory stress symptoms or PaO,/FI, ‘snot bserved lv witha double crcut is recommended. Avius iter should be installed between the mack and the exnalation valve when applying NIV with 2 single tube. Sultable masks should be ‘hosen to reduce the risk of vrs spread trough a eakage, (2) nvasive Mechanical vention {© Prneipies of invasive mechanical venation in rtcallyil patients Its important to balance the ventilation and oxygenation demands and the risk of ‘mecharical ventilation-related lung injury in the treatment of COVID-19 Svictly set the tidal volume to 4 ~8 mL/kg. In general, the lower the Lung compliance, the Smaller the preset tidal volume should be Maintainthe platform pressure <30.emb,0 (1 cmH 1098 KPa} ana diving pressure 15 Set PEEP according tothe ARDS's protocol Ventitation frequency: 18-25 times per minute. Moderate hypercapnia is allowed ‘Administer sedation, analgesia, or muscle relaxant ifthe tidal volume, plattarm pressure anaariving pressure ae too high