Distinct phenotypes require distinct respiratory management strategies in severe COVID-19.
COVID-19
Mechanical ventilation
Non-Invasive ventilation
Positive end expiratory pressure
Prone position
SARS-CoV-2
Journal
Respiratory physiology & neurobiology
ISSN: 1878-1519
Titre abrégé: Respir Physiol Neurobiol
Pays: Netherlands
ID NLM: 101140022
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
02
05
2020
revised:
04
05
2020
accepted:
04
05
2020
pubmed:
22
5
2020
medline:
5
8
2020
entrez:
22
5
2020
Statut:
ppublish
Résumé
Coronavirus disease 2019 (COVID-19) can cause severe respiratory failure requiring mechanical ventilation. The abnormalities observed on chest computed tomography (CT) and the clinical presentation of COVID-19 patients are not always like those of typical acute respiratory distress syndrome (ARDS) and can change over time. This manuscript aimed to provide brief guidance for respiratory management of COVID-19 patients before, during, and after mechanical ventilation, based on the recent literature and on our direct experience with this population. We identify that chest CT patterns in COVID-19 may be divided into three main phenotypes: 1) multiple, focal, possibly overperfused ground-glass opacities; 2) inhomogeneously distributed atelectasis; and 3) a patchy, ARDS-like pattern. Each phenotype can benefit from different treatments and ventilator settings. Also, peripheral macro- and microemboli are common, and attention should be paid to the risk of pulmonary embolism. We suggest use of personalized mechanical ventilation strategies based on respiratory mechanics and chest CT patterns. Further research is warranted to confirm our hypothesis.
Identifiants
pubmed: 32437877
pii: S1569-9048(20)30113-0
doi: 10.1016/j.resp.2020.103455
pmc: PMC7211757
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
103455Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors declare that they have no competing interests
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