Ventilation of coronavirus disease 2019 patients.
Curr Opin Crit Care
; 27(1): 6-12, 2021 02 01.
Article
in English
| MEDLINE | ID: covidwho-1290563
ABSTRACT
PURPOSE OF REVIEW To summarize the current knowledge of pathophysiology and ventilatory management of acute respiratory failure in COVID-19. RECENT FINDINGS:
Early reports suggested that COVID-19 is an 'atypical ARDS' with profound hypoxemia with normal respiratory system compliance (Crs). Contrarily, several more populated analyses showed that COVID-19 ARDS has pathophysiological features similar to non-COVID-19 ARDS, with reduced Crs, and high heterogeneity of respiratory mechanics, hypoxemia severity, and lung recruitability. There is no evidence supporting COVID-19-specific ventilatory settings, and the vast amount of available literature suggests that evidence-based, lung-protective ventilation (i.e. tidal volume ≤6âml/kg, plateau pressure ≤30âcmH2O) should be enforced in all mechanically ventilated patients with COVID-19 ARDS. Mild and moderate COVID-19 can be managed outside of ICUs by noninvasive ventilation in dedicated respiratory units, and no evidence support an early vs. late intubation strategy. Despite widely employed, there is no evidence supporting the efficacy of rescue therapies, such as pronation, inhaled vasodilators, or extracorporeal membrane oxygenation.SUMMARY:
Given the lack of evidence-based specific ventilatory strategies and a large amount of literature showing pathophysiological features similar to non-COVID-19 ARDS, evidence-based lung-protective ventilatory strategies should be pursued in all patients with COVID-19 ARDS.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Respiration, Artificial
/
Respiratory Distress Syndrome
/
COVID-19
Type of study:
Prognostic study
Limits:
Humans
Language:
English
Journal:
Curr Opin Crit Care
Journal subject:
Critical Care
Year:
2021
Document Type:
Article
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