Pan American Health Organization · Interim recommendations, 3 March 2020
Interim recommendations on minimum standards and technical specifications for medical equipment to support COVID-19 patient care.
- Issuer
- Pan American Health Organization
- Edition
- Interim recommendations, 3 March 2020
- Audience
- Health care providers, intensive care unit managers, ministries of health, procurement officers
- Evidence
- Expert consensus based on early COVID-19 clinical experience
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This interim guidance, issued 3 March 2020 by the Pan American Health Organization, provides technical specifications for medical devices required for supportive treatment of COVID-19 patients in healthcare settings. It was developed in response to the emerging pandemic when no specific antiviral treatment existed, making effective supportive therapy—oxygen, antibiotics, hydration and fever/pain relief—the cornerstone of care for severe manifestations.
The document presents detailed technical requirements for over 30 types of medical devices, from basic airway management equipment (Guedel airways, endotracheal tubes, laryngoscopes) to advanced life support systems (portable ventilators, non-invasive BiPAP ventilators, external defibrillators, cardiovascular ultrasound). Specifications cover early supportive therapy and monitoring of severe acute respiratory illness (SARI), management of hypoxaemic respiratory failure and acute respiratory distress syndrome (ARDS), and management of septic shock in COVID-19 patients.
The guidance is designed to be adaptable across countries with different healthcare systems and socioeconomic capacities. It provides minimum standards rather than comprehensive lists, enabling health facilities, intensive care unit managers and ministries of health to ensure appropriate equipment is available for suspected or confirmed COVID-19 cases. Two-level checklists distinguish equipment for early supportive/monitoring care from that required for management of hypoxaemic respiratory failure, ARDS and septic shock.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Severe COVID-19 cases defined as: dyspnoea, respiratory frequency ≥30/min, blood oxygen saturation ≤93%, PaO₂/FiO₂ ratio ≤300, and/or lung infiltrates >50% within 24–48 hours (14% of confirmed cases)
- Critically ill patients with respiratory failure, septic shock and/or multiple organ dysfunction represent 5% of confirmed cases
- Non-invasive ventilators (BiPAP) should provide CPAP/PEEP 4–25 cm H₂O, IPAP 4–40 cm H₂O, respiratory rate 4–60 breaths per minute, and FiO₂ 21–100%
- Portable ventilators must deliver tidal volume up to 1,000 ml, inspiratory pressure up to 80 cm H₂O, respiratory rate up to 60 breaths/min, PEEP up to 20 cm H₂O, pressure support up to 45 cm H₂O
- Oxygen concentrators must operate at temperatures 5–45°C with continuous monitoring and alerts for low output pressure, low oxygen concentration and power failure
- External defibrillators require biphasic waveform, minimum 220 Joules maximum energy, conductive area >50 cm² for adults (>15 cm² paediatric), charge time <10 seconds
- Portable aspirators must generate vacuum of at least 0.85 bar (650 mmHg), maximum vacuum 700 mmHg, minimum flow rate 5 litres liquid per minute, with twin 3-litre bottles
- Essential airway equipment includes Guedel airways (sizes 00, 0, 1 for children; 2, 3, 4 for adults), endotracheal tubes with and without cuffs (internal diameter 3–8.5 mm), laryngeal masks (sizes 1–6) and intercostal catheters (12–40 Fr)
Checklist for medical material for COVID-19 case management according to level of care
Table extracted from the guideline
| Item | Early supportive therapy & monitoring | Management of hypoxaemic respiratory failure, ARDS & septic shock |
|---|---|---|
| External defibrillator | ✓ | ✓ |
| Oxygen concentrators | ✓ | ✓ |
| Pulse oximeter | ✓ | ✓ |
| Resuscitator, adult | ✓ | ✓ |
| Resuscitator, child | ✓ | ✓ |
| Portable ventilator | ✓ | ✓ |
| Endotracheal tubes (with/without cuff) | — | ✓ |
| Laryngoscope | — | ✓ |
| Non-invasive ventilator (BiPAP) | — | ✓ |
| NIV mask (full face/oronasal) | — | ✓ |
| Portable aspirator/suction system | — | ✓ |
| Cardiovascular ultrasound imaging system | — | ✓ |
| Portable ultrasound scanner | — | ✓ |
| Percutaneous tracheostomy set | — | ✓ |
| Intercostal catheter/chest tube | — | ✓ |
Source: Pan American Health Organization, Technical specifications of medical devices for the case management of COVID-19 in healthcare settings. Reproduced in summary form.
From the guideline
Verbatim
“The implementation of timely, effective, and safe supportive therapies (oxygen, antibiotics, hydration & fever/pain relief) is the cornerstone of therapy for patients that develop severe manifestations of COVID-19.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and WHO consultant, I recognise this early pandemic guidance as foundational for equipment standardisation that remains relevant beyond COVID-19 for all severe respiratory illness management in Georgia and neighbouring countries. The technical specifications provide objective procurement criteria that help avoid substandard equipment—a persistent challenge in our region—and the two-tier model sensibly distinguishes between district hospital capabilities and referral centre requirements. Georgian colleagues implementing respiratory critical care should particularly note the specific ventilator alarm requirements and the emphasis on portable ultrasound for pneumothorax detection, which proved invaluable during our COVID-19 response. The main implementation caveat for the South Caucasus is maintenance capacity: many facilities acquired sophisticated ventilators and ultrasound systems during the pandemic without establishing service contracts or training biomedical engineers, resulting in expensive equipment becoming inoperable within months; sustainable deployment requires simultaneous investment in technical support infrastructure.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
This guidance remains relevant for Georgia and the South Caucasus region in strengthening surge capacity for respiratory pandemic preparedness and routine critical care services. Georgian healthcare facilities managing severe respiratory infections—whether COVID-19, influenza or other emerging pathogens—require the standardised equipment specifications outlined here. National procurement programmes should use these technical standards to ensure compatibility, quality and interoperability of critical care equipment across primary, secondary and tertiary facilities. The two-tier equipment model (early supportive care versus advanced ARDS management) aligns with Georgia’s referral system and can guide resource allocation between regional centres and the National Center for Disease Control’s designated infectious disease facilities. Countries in the region should adapt specifications to local electrical standards, maintenance capacity and supply chain realities while maintaining the minimum performance thresholds specified.
Questions this guideline answers
Quick answers
What oxygen delivery systems are recommended for COVID-19 patients?
The guidance recommends oxygen concentrators with flow splitters (0.125–2 L/min per outlet), nasal prongs for adults and children with approximately 2-metre tubing, Venturi masks providing FiO₂ 0.24–0.5 with oxygen inflow 4–15 L/min, and non-invasive ventilators (BiPAP) with full face or oronasal masks in sizes S, M, L and XL for more severe hypoxaemia.
What are the minimum specifications for portable ventilators?
Portable ventilators must deliver tidal volume up to 1,000 ml, inspiratory pressure up to 80 cm H₂O, respiratory rate up to 60 breaths/min (SIMV rate up to 40), PEEP up to 20 cm H₂O, pressure support up to 45 cm H₂O, and FiO₂ 21–100%. Required modes are volume controlled, pressure controlled, pressure support, SIMV with pressure support, assist/control and CPAP/PEEP. Essential alarms include FiO₂, minute volume, pressure, PEEP, apnoea, occlusion, high respiratory rate, disconnection, power failure and low battery.
What airway management equipment is needed for intubation?
Essential equipment includes: Guedel airways (sizes 00, 0, 1 for children; 2, 3, 4 for adults approximately 40–90 mm), laryngoscopes with straight Miller blade (size 1, 100 mm) and curved Macintosh blades (sizes 2–4, 110–155 mm), endotracheal tubes with cuffs (internal diameter 6.5–8.5 mm) and without cuffs (3–3.5 mm for paediatrics), laryngeal masks (sizes 1–6), tracheal tube introducers (bougies, 70 cm length, 14–15 Fr diameter), and oesophageal tracheal airways (Combitube) for difficult airways.
What monitoring equipment is essential for COVID-19 critical care?
Essential monitoring includes pulse oximeters measuring SpO₂ 30–100% and heart rate 20–250 bpm, portable ultrasound scanners with sectorial transducer (2–5 MHz) and linear transducer (5–10 MHz) for lung sliding assessment and pneumothorax detection (BLUE protocol), cardiovascular ultrasound systems with transoesophageal capability for advanced haemodynamic assessment, and colorimetric carbon dioxide detectors compatible with child and adult endotracheal tubes to confirm tube placement.
Related on GMJ
Interconnected resources
Dictionary of Public Health
Conditions A–Z
GMJ News coverage
- UK flu and COVID-19 surveillance data to May 2027 shows continued monitoring amid seasonal trendsOct 2026
- Community Health Workers Boost COVID-19 Testing Among Formerly Incarcerated PeopleAug 2026
- Cambridge researchers identify three distinct severe pneumonia subtypes, opening path to personalised treatmentSep 2026
- Five-year survival gap persists after septic shock discharge, study findsAug 2026
- Early Vasopressors Versus Fluid Resuscitation in Septic Shock: Major Trial Challenges Standard PracticeJul 2026
Quality & accreditation
Other guidelines on this topic
- Rehabilitation considerations during the COVID-19 outbreak
- Recommendations for Cleaning and Disinfection Public Places: Supermarkets, Markets, Neighborhood Stores, Banks, Public Transport, and Others
- Requirements and technical specifications of personal protective equipment (PPE) for the novel coronavirus (2019-nCoV) in healthcare settings
- Ongoing Living Update of Potential COVID-19 Therapeutics: summary of rapid systematic reviews
- Reorganization and Progressive Expansion of Health Services for the Response to the COVID-19 Pandemic
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Interim recommendations, 3 March 2020
- Status
- Current
- Published
- 2020-01-01
- Scope
- Technical specifications for medical devices for COVID-19 case management in healthcare settings
- Audience
- Health care providers, intensive care unit managers, ministries of health, procurement officers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on early COVID-19 clinical experience
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Technical specifications of medical devices for the case management of COVID-19 in healthcare settings: interim recommendations, 3 March 2020. Washington, D.C.: PAHO; 2020. (PAHO/PHE/IM/Covid-19/20-001). Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
Was this article helpful?
