Review article

COVID-19 and Mechanical Ventilation

Jasminka Peršec
Andrej Šribar

Abstract

Acute hypoxemic respiratory failure is the main clinical feature of COVID-19, and the most common reason for admission to the intensive care unit. In patients who develop such failure, the choice of respiratory support depends on the weakness of the respiratory system, with two forms of failure - preserved vs. failing respiratory mechanics. In patients with preserved respiratory mechanics, lung compliance is normal and hypoxemia is caused by loss of hypoxic pulmonary vasoconstriction. Prone positioning combined with high flow nasal oxygen (HFNO) or non-invasive ventilation (NIV) is the therapy of choice in these patients. When acute respiratory distress syndrome (ARDS) is present with COVID-19, the therapeutic approach is similar as with other viral pneumonias – initiation of mechanical ventilation via endotracheal tube, positive end expiratory pressure (PEEP) set to levels in which cyclic opening and closure of alveoli is avoided, and fraction of inspired oxygen set to lowest possible levels needed to achieve arterial oxygen saturation of 90%. In order to avoid patient-ventilator dyssynchrony, use of sedatives (such as midazolam or dexmedetomidine) and neuromuscular relaxants are recommended. Extracorporeal support methods such as ECMO and ECCO, which are proven to be effective when treating ARDS caused by other sources, have not shown adequate efficacy in COVID-19 patients.

Keywords

COVID-19; critical care; HFNO; mechanical ventilation; ECMO

Hrčak ID:

244323

URI

https://hrcak.srce.hr/244323

Publication date:

30.9.2020.

Article data in other languages: croatian

Visits: 5.591 *