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
Prone positioning improves oxygenation and lung recruitment in patients with SARS-CoV-2 acute respiratory distress syndrome; a single centre cohort study of 20 consecutive patients.
Jennifer Clarke,Jennifer Clarke,Pierce Geoghegan,Pierce Geoghegan,Natalie L McEvoy,Natalie L McEvoy,Maria Boylan,Orna Ní Choileáin,Martin Mulligan,Grace Hogan,Aoife Keogh,Oliver J. McElvaney,Oisín F. McElvaney,John Bourke,Bairbre McNicholas,John G. Laffey,Noel G. McElvaney,Gerard F. Curley,Gerard F. Curley +18 more
TL;DR: In this article, the effects of prone positioning on respiratory mechanics and oxygenation in invasively ventilated patients with SARS-CoV-2 ARDS were investigated. But, there was no significant difference in respiratory system static compliance with prone positioning.
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Transthoracic echocardiography during prone position ventilation: Lessons from the COVID-19 pandemic.
Edgar García-Cruz,Daniel Manzur-Sandoval,Rodrigo Gopar-Nieto,Adriana Lizeth Murillo-Ochoa,Gabriela Bejarano‐Alva,Gustavo Rojas-Velasco,Rolando J. Álvarez-Álvarez,Francisco M. Baranda-Tovar +7 more
TL;DR: The main objective was to show the feasibility of obtaining images to measure multiple parameters with transthoracic echocardiography during the prone position ventilation.
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Non-invasive oxygenation support in acutely hypoxemic COVID-19 patients admitted to the ICU: a multicenter observational retrospective study
Pedro D. Wendel-García,Arantxa Mas,C. González-Isern,Joan R. Masclans,E. Sandoval,Paula Vera,Rafael Fernandez,J.M. Sirvent,Mercedes Ibarz,José Luis Lopera,María Bodí,Joan Carles Yébenes-Reyes,Carles Triginer,I. Vallverdú,Anna Baró,P. Saludes,Mauricio Valencia,Arturo Huerta,Francisco José Cambra,Jorge Cabrero Echevarría,Oscar Peñuelas,Jordi Mancebo,Ricard Ferrer,Oriol Roca,Xavier Nuvials,Juan-Camilo Ruiz,Elisabeth Papiol,Rafael Mañez,V. D. Gumicio,G. Muñoz,David Toapanta,Paola Zúñiga Castro,Julio Osorio,J. Masclans,R. Muñoz-Bermúdez,Francisco José Parrilla,Purificación Pérez-Terán,Judith Marin-Corral,A. Mas,Beatriz Cancio,Sergio Hernandez-Marin,Melinda Rita Koborzan,Cruz Almira Briones,J. Trenado,Josep M. Sirvent,P. Sebastian,X. Saiz,M. I. Martínez,Pau Garro,Consuelo Pedrós,Emma Sola Vendrell,M. Rodriguez,G. Moreno,Juan Carlos Yébenes-Reyes,C Triginer,A. Baro,Mauricio Morales,F. Bodi,Pacita Cabulera Saludes,Jordi Cervelló,Mónica Valencia,Ferran Roche-Campo,D Franch-Llasat,Anka Krämer de Huerta,P Perez Santigosa,F.J. Cambra,S Benito,C. Barberà,Juan Echevarria,J. Mancebo,Janine A Santos,Jaume Baldirà,Antoni Betbesé,Marta Izura,Indalecio Morán,J. Carlos Suárez,Lluís Zapata,N. Rodriguez,Margalida Joy Torrens,Aguirre Cordón,Carlos Javier Villafáfila Gomila,Margarita Flores,Alberto Segarra,M.C. Juárez Morales,Leopoldo Mateo,Matthew Martos +85 more
TL;DR: In this paper , the authors used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.
Journal ArticleDOI
Evaluation of Oxygenation in 129 Proning Sessions in 34 Mechanically Ventilated COVID-19 Patients.
TL;DR: In summary, PP improved arterial oxygenation and reduced oxygen requirements in most Covid-19 patients in this single- center, retrospective analysis.
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Early, awake proning in emergency department patients with COVID-19.
Nicole M. Dubosh,Matthew L. Wong,Anne V. Grossestreuer,Ying K. Loo,Leon D. Sanchez,David Chiu,Evan L. Leventhal,Annette M. Ilg,Michael W. Donnino +8 more
TL;DR: Early, awake proning may be feasible in select COVID-19 patients and was associated with improved oxygenation, as well as feasibility, safety, and other physiological and clinical outcomes associated with this intervention.
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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