The virus develops from very mild symptoms, mild colds, to pneumonia that can lead to acute respiratory failure and ultimately to multiorgan failure with a mortality of 2 to 10%. In hospitalized patients, interstitial pneumonia and ARDS usually occur during the second week of treatment, 7 – 9 days from the onset of the disease. Non-invasive ventilation support has not been shown to be effective in treating this type of ARDS with the existing additional risk of increased disease spread to medical staff (open ventilation system). But delaying invasive ventilation support often leads to worsening of the patient's condition. Patients with a saturation of 75 – 80% and PaO2 / FiO2 <150 require invasive ventilation treatment. Fulminant cardiomyopathy may occur in these patients even in the stages of recovery from the disease. It is not yet clear whether the infection causes viral cardiomyopathy or whether cardiac dysfunction is due to a cytokine storm. Early weaning from mechanical ventilation is one of the key aspects of successful treatment of patients with COVID-19 because respiratory support in general was borderline indicated in most cases. Prolonged ventilation of patients for more than 5 – 7 days creates conditions for the colonization of other pathogens, often resistant bacteria and fungi that encounter a markedly weakened immune response of the host, which significantly shortens and accelerates the path to sepsis. Good organization of intensive care units with clearly defined protocols is important for the control and successful treatment of the most severe COVID-19 respiratory infections. Such units must have a sufficient number of medical staff, primarily meaning the most experienced intensive care physicians, and medical technicians who are essentially the most important personnel.