COVID-19 Does Not Lead to a "Typical" Acute Respiratory Distress Syndrome.
Luciano Gattinoni,Silvia Coppola,Massimo Cressoni,Mattia Busana,Sandra Rossi,Davide Chiumello +5 more
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TLDR
It is found that hypercapnia was common in patients with COVID-19–associated ARDS while using low VT ventilation, and low VT may not be the best approach for all patients with ARDS, particularly those with a less severe decrease in respiratory system compliance and inadequacy of ventilation.Abstract:
ventilation strategy was applied to the first four patients to increase pulmonary efficiency to eliminate CO2, and this was used in the next four patients. Gas exchange consists of oxygenation and ventilation. Oxygenation is quantified by the PaO2/FIO2 ratio, and this method has gained wide acceptance, particularly since publication of the Berlin definition of ARDS (7). However, the Berlin definition does not include additional pathophysiological information about ARDS, such as alveolar ventilation, as measured by pulmonary dead space, which is an important predictor of outcome (8). Increased pulmonary dead space reflects the inefficiency of the lungs to eliminate CO2, which may lead to hypercapnia. In our patients with ARDS with COVID-19, hypercapnia was common at ICU admission with low VT ventilation. Assuming the anatomic portion of dead space is constant, increasing VT with constant respiratory rate would effectively increase alveolar ventilation. Any such increase in VT would decrease PaCO2, which would be captured by VR (6). VR, a novel method to monitor ventilatory adequacy at the bedside (4–6), was very high in our patients, reflecting increased pulmonary dead space and inadequacy of ventilation. With an acceptable plateau pressure and driving pressure, titration of VT was performed. PaCO2 and VR were significantly decreased when an intermediate VT (7–8 ml/kg PBW) was applied. We suggest that intermediate VT (7–8 ml/kg PBW) is recommended for such patients. Therefore, low VT may not be the best approach for all patients with ARDS, particularly those with a less severe decrease in respiratory system compliance and inadequacy of ventilation. In summary, we found that hypercapnia was common in patients with COVID-19–associated ARDS while using low VT ventilation. VR was increased in these patients, which reflected increased pulmonary dead space and inadequacy of ventilation. An intermediate VT was used to correct hypercapnia efficiently, while not excessively increasing driving pressure. Clinicians must have a high index of suspicion for increased pulmonary dead space when patients with COVID19–related ARDS present with hypercapnia. nread more
Citations
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Journal ArticleDOI
COVID-19 pneumonia: Therapeutic implications of its atypical features
OtherDOI
Lung, Heart Disease, and Other Organ Damage
TL;DR: The lung disease is characterized as an atypical acute respiratory distress syndrome (ARDS), with greater vascular involvement and relatively normal lung compliance compared to usual ARDS consolidation in acute COVID-19 patients as discussed by the authors .
Peer Review
Critically ill COVID-19 patient Critically ill COVID-19 patient
TL;DR: In this review, the crucial points regarding intensive care management of COVID-19 patients are emphasized, which have been written not only for intensivists but also for all healthcare professionals.
Posted ContentDOI
Trajectories of Hypoxemia & Respiratory System Mechanics of COVID-19 ARDS in the NorthCARDS dataset
Daniel Jafari,Amir Gandomi-Sereshki,Alex Makhnevich,Michael Qiu,Daniel M Rolston,Eric Gottesman,Adey Tsegaye,Paul H. Mayo,Molly Stewart,Meng Zhang,Negin Hajizadeh,Negin Hajizadeh +11 more
TL;DR: In this paper, a multidisciplinary team of frontline clinicians and data scientists created the Northwell COVIDARDS dataset (NorthCARDS) leveraging over 11,542 COVID-19 hospital admissions Data was summarized to describe differences based on clinically meaningful categories of lung compliance, and compared to non-COVIDARDS reports.
Book ChapterDOI
Ventilatory Support in Patients with COVID-19.
Paolo Maria Leone,Matteo Siciliano,Jacopo Simonetti,Angelena Lopez,Tanzira Zaman,Francesco Varone,Luca Richeldi +6 more
TL;DR: In this article, the potentials of ventilatory support as therapeutic options for adult and pediatric patients affected by COVID-19 pneumonia were illustrated. But no specific therapeutic drugs or vaccines have been proven efficacious.
References
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Journal ArticleDOI
Acute respiratory distress syndrome: the Berlin Definition.
Ards Definition Task Force,V. Marco Ranieri,Gordon D. Rubenfeld,B. Taylor Thompson,Niall D. Ferguson,Ellen Caldwell,Eddy Fan,Luigi Camporota,Luigi Camporota,Arthur S. Slutsky +9 more
TL;DR: The updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition and may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
Journal ArticleDOI
Lung Recruitment in Patients with the Acute Respiratory Distress Syndrome
Luciano Gattinoni,Pietro Caironi,Massimo Cressoni,Davide Chiumello,V. Marco Ranieri,Michael Quintel,Sebastiano G. Russo,Nicolò Patroniti,Rodrigo Cornejo,Guillermo Bugedo +9 more
TL;DR: In ARDS, the percentage of potentially recruitable lung is extremely variable and is strongly associated with the response to PEEP, which may decrease ventilator-induced lung injury by keeping lung regions open that otherwise would be collapsed.
Journal ArticleDOI
Mechanical Ventilation to Minimize Progression of Lung Injury in Acute Respiratory Failure
TL;DR: It is argued that application of a lung-protective ventilation, today best applied with sedation and endotracheal intubation, might be considered a prophylactic therapy, rather than just a supportive therapy, to minimize the progression of lung injury from a form of patient self-inflicted lung injury.
Journal ArticleDOI
Prone Position in Acute Respiratory Distress Syndrome. Rationale, Indications, and Limits
TL;DR: The bulk of data indicates that in severe acute respiratory distress syndrome, carefully performed prone positioning offers an absolute survival advantage of 10-17%, making this intervention highly recommended in this specific population subset.
Journal ArticleDOI
Lung Recruitability in COVID-19-associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study.
Chun Pan,Lu Chen,Cong Lu,Cong Lu,Wei Zhang,Jia An Xia,Michael C. Sklar,Michael C. Sklar,Bin Du,Laurent Brochard,Laurent Brochard,Haibo Qiu +11 more
TL;DR: A new mechanics-based index is described to directly quantify the potential for lung recruitment, called the recruitment-to-inflation ratio (R/I ratio), which estimates how much of an increase in endexpiratory lung volume induced by PEEP is distributed between the recruited lung (recruitment) and the inflation and/or hyperinflation of the “baby lung” when a higher PEP is applied.
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