Mechanical Ventilation in Sepsis

Sepsis can cause lung injury. Prior to the COVID-19 pandemic, sepsis was the main cause of acute respiratory distress syndrome (ARDS), associated with approximately >50% of cases. Mechanical ventilation (MV) may amplify the lung-specific inflammatory response in preinjured lungs by elevating cytokine release and augmenting damage to the alveolar integrity;in addition, sepsis per se constitutes a risk factor for mechanical ventilator-induced lung injury. Inadequate ventilator setting can contribute to increased infection-induced organ failure and uncontrolled systemic inflammatory response. Objectives of invasive MV are to maintain adequate gas exchange: maintain oxygenation goals and adequate ventilation. Regarding ventilatory modes, it has been proposed that volume control-continuous mandatory ventilation may be more protective than pressure control-continuous mandatory ventilation. It may be reasonable to maintain a target arterial partial pressure of oxygen of 60–80mm Hg (Young et al. 2022) or a saturation of peripheral oxygen of 92%–96% for most patients. Sepsis-induced diaphragmatic dysfunction is a major risk factor of weaning failure during MV. Diaphragmatic ultrasound had been a useful tool for predicting successful liberation from MV. Another important aspect of ventilation is the type of sedation to use. © 2023 Elsevier Inc. All rights reserved.

Advantages and limitations of the ROX index

Dear editor We have read with interest the study by Vega et al1 published in the latest issue of the journal, where the authors propose the ROX index as a predictor of failure of high-flow nasal cannula (HFNC) therapy in patients with pneumonia due to SARS-CoV-2, and we would like to share some considerations on the advantages and disadvantages of using this index.

Antimicrobial use and abuse in COVID-19: When is its use justified?

The pandemic due to coronavirus disease 2019 (COVID-19) caused by the SARSCoV- 2 virus has created challenges for its diagnosis and treatment. To date, there is no specific antiviral therapy, this situation has pressured the clinician to offer alternative pharmacological therapies whose benefits may be overshadowed by their risks. Since the beginning of the pandemic, the use of empirical antibiotics has become popular in various treatment protocols worldwide, a treatment that is not recommended in national or international guidelines for the management of COVID-19. Current evidence shows a low incidence of bacterial coinfections, even in severe conditions. Administering an antibiotic incorrectly when there is no indication supported by clinical studies is associated with significant deleterious effects, such as increased mortality. Given the similarity of the infectious clinical picture of COVID-19 with an atypical bacterial pneumonia, ruling out an infectious process in a concise and timely manner is of great importance;for this, biochemical and imaging studies can be done, in addition to a good clinical integration of the patient's signs and symptoms. This review describes the collection of evidence on bacterial coinfections in COVID-19, the prescription of antibiotics in this disease, and the possible consequences.