Initial emergency department mechanical ventilation strategies for COVID-19 hypoxemic respiratory failure and ARDS - 25/11/20

Doi : 10.1016/j.ajem.2020.06.082

Skyler Lentz ^a, Matthew A. Roginski ^b, Tim Montrief ^c, Mark Ramzy ^d, Michael Gottlieb ^e, Brit Long ^f,^{^⁎}
^a Division of Emergency Medicine, Department of Surgery, The University of Vermont Larner College of Medicine, USA
^b Divisions of Emergency Medicine and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, USA
^c Department of Emergency Medicine, Jackson Memorial Health System, USA
^d Department of Emergency Medicine, Maimonides Medical Center, USA
^e Department of Emergency Medicine, Rush University Medical Center, USA
^f SAUSHEC, Emergency Medicine, Brooke Army Medical Center, USA

^⁎Corresponding author at: 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA3841 Roger Brooke Dr, Fort Sam HoustonTX78234USA

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Abstract

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging viral pathogen that causes the novel coronavirus disease of 2019 (COVID-19) and may result in hypoxemic respiratory failure necessitating invasive mechanical ventilation in the most severe cases.

Objective

This narrative review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.

Discussion

In severe cases, COVID-19 leads to hypoxemic respiratory failure that may meet criteria for acute respiratory distress syndrome (ARDS). The mainstay of treatment for ARDS includes a lung protective ventilation strategy with low tidal volumes (4–8 mL/kg predicted body weight), adequate positive end-expiratory pressure (PEEP), and maintaining a plateau pressure of < 30 cm H₂O. While further COVID-19 specific studies are needed, current management should focus on supportive care, preventing further lung injury from mechanical ventilation, and treating the underlying cause.

Conclusions

This review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.

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Keywords : SARS-CoV-2, COVID-19, Acute respiratory distress syndrome, Respiratory failure, Lung protective strategy, Mechanical ventilation

Plan

Introduction

Methods

Discussion

Pathophysiology of acute respiratory distress syndrome and COVID-19

A lung protective strategy

An individualized approach

Additional therapies in ARDS

An initial approach to COVID-19 hypoxemic respiratory failure

Conclusion

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Vol 38 - N° 10

P. 2194-2202 - octobre 2020 Retour au numéro

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Initial emergency department mechanical ventilation strategies for COVID-19 hypoxemic respiratory failure and ARDS - 25/11/20

Abstract

Introduction

Objective

Discussion

Conclusions

Plan

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