Abstract
The novel coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory
syndrome-coronavirus-2 (SARS-CoV-2) is causing significant morbidity and mortality
worldwide. The common presentations in children include involvement of respiratory
system leading to pneumonia and acute respiratory distress syndrome, as well as multiorgan
dysfunction syndrome and multisystem inflammatory syndrome in children (MIS-C). Pediatric
COVID-19 is a milder disease as compared with the adults. Also, there is rise in MIS-C
cases which is a hyperinflammatory condition temporally associated with SARS-CoV-2.
Since respiratory system is predominantly involved, few of these critically ill children
often require respiratory support which can range from simple oxygen delivery devices,
high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), invasive mechanical
ventilation, and extracorporeal membrane oxygenation (ECMO). Most of the oxygen delivery
devices and respiratory interventions generate aerosols and pose risk of transmission
of virus to health care providers (HCPs). The use of HFNC and NIV should be limited
to children with mild respiratory distress preferably in negative pressure rooms and
with adequate personal protective equipment (PPE). However, there should be low thresholds
for intubation and invasive mechanical ventilation in the event of clinical deterioration
while on any respiratory support. The principle of providing respiratory support requires
special droplet and air-borne precautions to limit exposure or transmission of virus
to HCPs and at the same time ensuring safety of the patient.
Keywords
COVID-19 - noninvasive ventilation - high-flow nasal cannula - personal protective
equipment - mechanical ventilation
