Managing a patient on a COVID-19 cohort area (ward)

The management of patients on a COVID-19 ward necessitated a separate management guideline to support frontline teams; Management of oxygenation failure on COVID-19 wards. This document can be found below, downloaded and printed for use on a COVID-19 ward.

Patients with COVID-19 who are admitted to hospital are likely to have oxygenation failure, and therefore the first step of the guideline is to administer oxygen therapy, until the patient reaches the target saturations 90-94%:

  1. Nasal cannulae (up to 4 litres/minute oxygen)
  2. Husdon face mask, aka simple face mask (5 – 10 litres/minute oxygen)
  3. Non-rebreather mask, aka mask with a reservoir bag (10 – 15 litres/minute oxygen
  4. Respiflo system up to FiO2 of 98%

In addition, these patients may require fluid support, their co-morbidities managed, and pending the results of a throat swab they should be treated with antibiotics according to the Antibiotic Management of patients with suspected COVID-19 guidelines (also found below). Patients should also receive thromboprophylaxis treatment to prevent venous thromboembolisms.

Dexamethasone and Remdesivir should be administered according to local guidance and CTAG flow chart (linked below).

If the patient is not improving on oxygen therapy after 30 minutes, CPAP therapy should be administered, alternating between CPAP therapy and prone self-ventilation. CPAP (10cmH2O) with entrained oxygen (15 litres/minute), via a full-face non-vented face mask should be delivered to the patient, aiming for target oxygen saturations 90-94%. Patients should be monitored and CPAP pressures can be increased in 2cmH2O increments to achieve the target oxygen saturations. By increasing the CPAP pressure, this will reduce the FiO2 running through the patient’s circuit, so it’s important to find a balance for the patient.

If the patient does not tolerate CPAP therapy, there is a role for High-Flow Nasal Oxygen (HFNO) up to 60litres/minute.

If there is no improvement (SpO2 remains less than 90%), the patient should be escalated to ITU (where suitable) or continued management on a COVID-19 ward.

If a patient is deteriorating rapidly on oxygen therapy or CPAP or HFNO, and they are not deemed suitable candidate for intensive care, there is a palliative care guideline (also below) that will support in the management of these patients to ensure their symptoms are controlled and they do not become distressed.

Last updated 23/11/2020

Mark as Understood


All Wales COVID-19 Secondary Care Management Guideline

Antibiotic Management of patients with suspected COVID-19

Secondary Care Community Acquired Pneumonia Guideline

Guideline on the Management of Oxygenation Failure on a COVID-19 Ward

© Institute of Clinical Science and Technology (ICST) 2020