Liječnički vjesnik, Vol. 142 No. 3-4, 2020.
Review article
https://doi.org/10.26800/LV-142-3-4-15
Specific aspects of respiratory support in COVID-19 patients
Jasminka Peršec
; Primarni respiratorni centar za liječenje bolesnika oboljelih od COVID-19, Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Stomatološki fakultet Sveučilišta u Zagrebu, Klinička bolnica Dubrava, Zagreb
Andrej Šribar
; Primarni respiratorni centar za liječenje bolesnika oboljelih od COVID-19, Klinika za anesteziologiju, reanimatologiju i intenzivnu medicinu, Stomatološki fakultet Sveučilišta u Zagrebu, Klinička bolnica Dubrava, Zagreb
Abstract
Acute hypoxemic respiratory failure is the main clinical feature of COVID-19 responsible for ICU admission. In patients who develop respiratory failure,the choice of respiratory support depends on changes in respiratory mechanics, and the goal of this article is to differentiate between clinical and pathophysiological features beneath the respiratory failure in order to select optimal treatment. 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, 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 (FIO2) set to lowest possible levels needed to achieve arterial oxygen saturation of 90%.In order
to avoid patient-ventilator dyssynchrony the use of sedatives (such as midazolam or dexmedetomidine) and neuromuscular relaxants is recommended. Extracorporeal support methods, such as extracorporeal membrane oxygenation and carbon dioxide removal which are proven to be effective when treating ARDS caused by other causes have not shown adequate efficacy in COVID-19 patients.
Keywords
BETACORONAVIRUS; CORONAVIRUS INFECTIONS – complications, diagnosis, therapy; PNEUMONIA, VIRAL – complications, diagnosis, therapy; CRITICAL CARE – methods; RESPIRATORY INSUFFICIENCY – therapy; RESPIRATORY DISTRESS SYNDROME, ADULT – diagnosis, physiopathology, therapy; HYPOXIA – physiopathology; OXYGEN INHALATION THERAPY – methods; RESPIRATION, ARTIFICIAL – methods; NONINVASIVE VENTILATION; POSITIVE-PRESURE RESPIRATION; EXTRACORPOREAL MEMBRANE OXYGENATION
Hrčak ID:
238510
URI
Publication date:
8.6.2020.
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