Características de la ventilación mecánica invasiva en COVID-19 para médicos no especialistas / Characteristics of invasive mechanical ventilation in COVID-19 for non-specialist medical

ABSTRACT

SARS-CoV-2 is the agent responsible for COVID-19, the current pandemic, which is characterized by developing respiratory disturbances that are associated with severe hypoxemia associated with symptoms of non-bacterial pneumonia, ARDS up to multi-organ failure. It has been characterized by presenting 2 different phenotypes (phenotype L and phenotype H), with phenotype H being a stage of progressive deterioration of phenotype L, which depends on the earliness with which ventilatory management begins and the degree of inflammatory compromise. However, since VMI can generate VILI, the use of protective ventilation has been recommended as a ventilatory strategy for COVID-19. This review aims to comment on the available evidence of the essential aspects of protective IMV in the context of ARDS associated with COVID-19, in addition to the use of neuromuscular blockade and prone strategies.

RESUMEN

El SARS-CoV-2 es el agente responsable del COVID-19, actual pandemia, que se caracteriza por desarrollar alteraciones respiratorias que cursan con hipoxemia severa asociada a cuadros de neumonía no bacteriana, SDRA hasta la falla multiorgánica. Se ha caracterizado por presentar 2 fenotipos distintos (fenotipo L y fenotipo H), siendo el fenotipo H un estadío de deterioro progresivo del fenotipo L, que depende de la precocidad con la que se inicia el manejo ventilatorio y del grado de compromiso inflamatorio. Sin embargo, dado que la VMI puede generar VILI, se ha recomendado el uso de una ventilación protectora como estrategia ventilatoria para COVID-19. La presente revisión tiene como objetivo comentar la evidencia disponible de los aspectos esenciales de la VMI protectora en el contexto del SDRA asociado a COVID-19, además del uso de bloqueo neuromuscular y las estrategias de prono.