CHEST Guidelines & Resources Guidelines, Statements, and Research

COVID-19: Guidelines, Statements, and Research

Access guidelines, statements, and key research related to the management of patients with COVID-19 and the delivery of critical care during the pandemic.

National Institutes of Health COVID-19 Treatment Guidelines

These evolving guidelines from NIH provide recommendations based on scientific evidence and expert opinion as determined by a panel of representatives from federal agencies, health care and academic organizations, and professional societies, including CHEST members Steven Q. Simpson, MD, FCCP; Mitchell M. Levy, MD; and Gregory S. Martin, MD, MSc, FCCP.


This CHEST series highlights specific studies in the COVID-19 literature that may warrant discourse or reading for members of the chest medicine community. Articles are written by members of CHEST NetWorks.

Immunomodulation Therapy in Severe COVID-19 Infection: Where Do We Stand?

By: Damaris E. Pena Evertz, MD, and Bharat Bajantri, MD
Clinical Research and Quality Improvement NetWork

Published: June 15, 2021

How effective is immunomodulation therapy in treating patients with severe COVID-19 infection? Learn about the research into various treatments.

Clinical Outcomes of COVID-19 in Patients With COPD

By: SM Abdullah Al Mamun, MD, MBBS, FCCP; Muhammad Adrish, MD, MBA, FCCP; Tamer Hudali, MD, MPH; Mahesh Padukudru Anand, DNB, MBBS, FCCP; Fernando Fuentes, MD; Sarang Patil, MD; Kadambari Vijaykumar, MD; and Navitha Ramesh, MD, MBBS, FCCP
Airways Disorders NetWork

Published: June 15, 2021

Understand the increased risk of severe COVID-19 in patients with COPD, as well as strategies for implementing telehealth for patients with COPD during the pandemic.

Diagnosis and Containment of Patients With Suspected Lung Cancer in the COVID-19 Pandemic—What Does the Literature Say?

By: Jasleen Pannu, MD
Thoracic Oncology NetWork

Published: June 2, 2021

The COVID-19 pandemic has had a detrimental impact on the already complex care of patients with lung cancer.

Safety of Bronchoscopy During the COVID-19 Pandemic: An Update

By: Abhishek Sarkar, MD; Abhinav Agrawal, MD, DAABIP; Anne Valerie Gonzalez, MD, FCCP; Fabien Maldonado, MD, FCCP; and Christina MacRosty, DO
Interventional/Chest Diagnostic Procedures NetWork

Published: May 18, 2021

More than a year after the start of the pandemic, we reflect upon the evidence regarding bronchoscopy during the COVID-19 pandemic.

Proning in COVID-19 Patients

By: Mary Jo Farmer, MD, PhD, FCCP; Claudia Onofrei, MD, MSc; and Salim Surani, MD, MPH, MSHM, FCCP
Clinical Pulmonary Medicine NetWork

Published: May 17, 2021

Prone positioning with or without mechanical ventilation has been widely adopted in treating patients with respiratory failure due to COVID-19. Previous experience in patients with moderate to severe acute respiratory distress syndrome demonstrated a survival benefit associated with early application of prone positioning.

Pulmonary Vasculopathy and Thrombosis in Patients with COVID-19

By: Dana Kay, DO; Sandeep Sahay, MD, MSc, FCCP; and Jean M. Elwing, MD, FCCP
Pulmonary Vascular Disease NetWork

Published: May 7, 2021

COVID-19 has proven to affect multiple organ systems through the activation of inflammatory and coagulation cascades. One fundamental area researched has been the pulmonary vascular changes and the incidence of thrombosis observed in COVID-19 patients.

COVID-19 and Pregnancy

By: Amik Sodhi, MD; Dipen Kadaria, MD; Jorge Trabanco, MD; Zachary Burden, MD; and Mariam Louis, MD
Women’s Lung Health NetWork

Published: April 30, 2021

Find out whether COVID-19 is more severe in pregnancy, how the disease may affect the fetus/neonate, whether pregnant patients should get the COVID-19 vaccine, and current recommendations regarding the relationship of the COVID-19 vaccine to fertility.

Operationalizing Crisis Standards of Care: The Potential Hazards of Relying on SOFA Scores for Resource Allocation

By: Brandon Corbett Walsh, MD, MBE, and Aloke Chakravarti, MD, FCCP
Disaster Response and Global Health NetWork

Published: April 23, 2021

A utilitarian resource allocation policy requires a prognostication model that aims to select individuals who are most likely to survive, but does so in a fair, transparent, and consistent manner that does not worsen existing health disparities. To date, however, no prognostication tool exists to predict mitigated outcomes of critical illness during a pandemic.

Post-COVID-19 Recovery Care: The Need for the Interprofessional Approach

By: Mary Jo S. Farmer, MD, PhD, FCCP, and Munish Luthra, MD, FCCP
Interprofessional Team NetWork

Published: April 22, 2021

Multipronged, interprofessional collaborative recovery care programs are urgently required to identify and address the unique needs of COVID-19 survivors and adapt to the shifting logistical landscape of the ongoing pandemic.

Toci Si or Toci No – The Tocilizumab Dilemma

By: Marcos I. Restrepo, MD, MSc, PhD, FCCP
Chest Infections NetWork

Published: April 19, 2021

Despite the use of corticosteroids, the mortality rate in severe and critical cases of COVID-19 remains unacceptably high. This is why the Chest Infections NetWork has chosen to review the literature on the use of tocilizumab (TCZ) to suggest alternatives for clinicians to improve survival among critically ill patients affected by COVID-19.

Aerosolization Risks of Noninvasive Ventilation in the Era of COVID-19

By: Sherri L. Katz, MDCM, MSc, FRCPC, FCCP; Meredith Kendall Greer, MD; and Ashima S. Sahni, MD, FCCP
Home-Based Mechanical Ventilation and Neuromuscular Disease Network

Published: April 9, 2021

Noninvasive ventilation is widely used in the treatment of patients with both acute and chronic respiratory disease. Understand the aerosolization risks of NIV in the era of COVID-19.

Aerosol Generation Risk of Chest Physiotherapy and Airway Clearance Techniques in Patients With COVID-19

By: Sherri L. Katz, MDCM, MSc, FRCPC, FCCP; Meredith Kendall Greer, MD; and Ashima S. Sahni, MD, FCCP
Home-Based Mechanical Ventilation and Neuromuscular Disease Network

Published: April 9, 2021

Certain precautions are necessary when delivering chest physiotherapy and airway clearance in patients with COVID-19, given the possibility of greater aerosolization of secretion with these therapies.

Asthma and COVID-19

By: Farrukh Abbas, MBBS; Diego Maselli, MD, FCCP; Mahesh Padukudru Anand, MBBS, FCCP; and Navitha Ramesh, MD, MBBS, FCCP
Airways Disorders NetWork

Published: March 22, 2021

Asthma exacerbations triggered by viral infections can be associated with adverse outcomes. Are asthma patients at increased risk of complications from COVID-19-related respiratory disease? Recent evidence suggests otherwise.

Timing of Intubation in Patients With COVID-19

By: Casey Cable, MD, MSc; David Bell, MD; Alice Gallo de Moraes, MD; and Viren Kaul, MD
Critical Care NetWork

Published: March 16, 2021

The timing of intubation in hypoxemic patients with COVID-19 has been hotly debated, with experience and guidelines evolving over the course of the pandemic. However, the clinical question persists: When is the “right time” to intubate hypoxemic patients with COVID-19?

Obstructive Sleep Apnea as a Risk Factor for Adverse Outcomes in COVID-19

By: Kara Dupuy-McCauley, MD, and Lauren Tobias, MD
Sleep Medicine NetWork

Published: March 3, 2021

Obstructive sleep apnea (OSA) shares several risk factors with COVID-19, including an increased incidence and severity in patients with male sex, obesity, hypertension, diabetes mellitus, and cardiovascular disease. The authors briefly review emerging literature that suggests OSA may be an independent risk factor for poor outcomes from COVID-19.


COVID-19 and Medical Education infographic

Medical Education During the COVID-19 Pandemic

Journal CHEST
December 29, 2020

The COVID-19 pandemic has impacted all aspects of medical education. A recent article in the journal CHEST outlines challenges experienced by trainees and programs alike due to the economic repercussions of the pandemic, social distancing, redeployment of personnel, and more.

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The US Strategic National Stockpile (SNS) Ventilators in COVID-19: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices

Journal CHEST
September 20, 2020


New York City and Boston were severely affected with the onset of the COVID-19 pandemic in March-April 2020. Pre-existing Strategic National Stockpile (SNS) ventilators were used to treat patients in these areas; but with concerns of a shortage, the US government, under the Defense Production Act, initially ordered about 200,000 new ventilators (subsequently decreased to 130,000 in August 2020).

  • Fifteen different types of ventilators were ordered from 11 manufacturers, and these efforts provided an additional stockpile of new SNS ventilators that would be available for use if the pandemic surged again to severe levels.
  • Patients with COVID-19 had varying degrees of respiratory failure, up to severe ARDS. Pre-existing SNS ventilators worked well for most, but not all, of these patients.
  • Most importantly, only some of the new SNS ventilators have the functional capability to support all COVID-19 patients; the remaining ventilators have other important uses, including care of less severely ill patients, transport, and noninvasive ventilation.
  • It is crucial that professionals who may be receiving or ordering these new SNS ventilators (including those being sent to other countries) understand the functionality and limitations of the ventilators.
  • The addition of 15 different types of ventilators to the SNS creates challenges for ongoing maintenance, including considerable costs and training of end users.

Drug shortages

It Takes a Village… Contending With Drug Shortages During Disasters

Journal CHEST
August 13, 2020

Drug shortages have become more common in recent years. A recent article published in the journal CHEST outlines methods for health systems to mitigate common drug shortages, as well as strategies for medication substitution in times of shortage.

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Recovery Trial

Dexamethasone in Hospitalized Patients with COVID-19—Preliminary Report

New England Journal of Medicine
July 17, 2020

According to results from the RECOVERY Trial, published in the New England Journal of Medicine, dexamethasone is the first therapeutic agent shown to reduce mortality due to COVID-19. Review the key takeaways from this trial.

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Joint Statement on Importance of Wearing Facial Coverings

American College of Chest Physicians, American Lung Association, American Thoracic Society, and COPD Foundation
July 17, 2020

CHEST has joined with the American Lung Association, American Thoracic Society, and COPD Foundation to release a statement on the importance of patients with chronic lung disease wearing facial coverings during the COVID-19 pandemic. Key points of the statement include:

  • The role of the facial coverings as a component of mitigation, along with social distancing, to decrease the spread of COVID-19 is a public health priority.
  • The general public should avoid using N95 masks so as to not deplete this resource for frontline workers.
  • Though face masks and face shields should not be viewed interchangeably, available data suggest face shields can reduce the amount of inhalation exposure to another droplet-spread respiratory virus, namely influenza.
  • Individuals with normal lungs and even many individuals with underlying chronic lung disease should be able to wear a non-N95 facial covering without affecting their oxygen or carbon dioxide levels.

Use of Tracheostomy During the COVID-19 Pandemic: CHEST/AABIP/AIPPD: Expert Panel Report

American College of Chest Physicians
June 5, 2020

This expert panel report examines the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and provides recommendations to guide health-care providers, including the following:

  • Either open surgical tracheostomy or percutaneous dilatational tracheostomy can be performed in COVID-19 patients when prolonged mechanical ventilation is anticipated.
  • Tracheostomy should be performed in a negative-pressure room, preferably in the ICU, by a team consisting of the least number of providers with the highest level of experience wearing enhanced personal protective equipment.
  • There is insufficient evidence for recommending specific timing for tracheostomy in COVID-19-related respiratory failure.
  • Routine RT-PCR testing (nasopharyngeal swab or lower respiratory sample) prior to performing tracheostomy in patients with confirmed COVID-19-related respiratory failure is not recommended.
  • Patients should be maintained with a closed circuit while on mechanical ventilation with a tracheostomy tube and with inline suction.



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