Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review.
Denise Battaglini,Denise Battaglini,Chiara Robba,Lorenzo Ball,Pedro L. Silva,Pedro L. Silva,Fernanda F. Cruz,Fernanda F. Cruz,Paolo Pelosi,Patricia R. M. Rocco,Patricia R. M. Rocco +10 more
TLDR
In this article, the authors provide an overview of P-SILI pathophysiology and the role of non-invasive respiratory support in COVID-19 pneumonia, and decide on the optimal timing of intubation for these patients.Abstract:
COVID-19 pneumonia is associated with hypoxaemic respiratory failure, ranging from mild to severe. Because of the worldwide shortage of ICU beds, a relatively high number of patients with respiratory failure are receiving prolonged noninvasive respiratory support, even when their clinical status would have required invasive mechanical ventilation. There are few experimental and clinical data reporting that vigorous breathing effort during spontaneous ventilation can worsen lung injury and cause a phenomenon that has been termed patient self-inflicted lung injury (P-SILI). The aim of this narrative review is to provide an overview of P-SILI pathophysiology and the role of noninvasive respiratory support in COVID-19 pneumonia. Respiratory mechanics, vascular compromise, viscoelastic properties, lung inhomogeneity, work of breathing, and oesophageal pressure swings are discussed. The concept of P-SILI has been widely investigated in recent years, but controversies persist regarding its mechanisms. To minimise the risk of P-SILI, intensivists should better understand its underlying pathophysiology to optimise the type of noninvasive respiratory support provided to patients with COVID-19 pneumonia, and decide on the optimal timing of intubation for these patients.read more
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Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis.
Brigitta Fazzini,Alexandria Page,Rupert M Pearse,Rupert M Pearse,Zudin Puthucheary,Zudin Puthucheary +5 more
TL;DR: In this paper, a systematic review and meta-analysis evaluated the effect, timing, and populations that might benefit from awake proning regarding oxygenation, mortality, and tracheal intubation compared with supine position in hypoxaemic acute respiratory failure.
Journal ArticleDOI
Prone positioning for non-intubated spontaneously breathing patients with acute hypoxaemic respiratory failure: a systematic review and meta-analysis
TL;DR: A systematic review and meta-analysis evaluated the effect, timing, and populations that might benefit from awake proning regarding oxygenation, mortality, and tracheal intubation compared with supine position in hypoxaemic acute respiratory failure as discussed by the authors .
Journal ArticleDOI
Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial
Miguel A Ibarra-Estrada,Jie Li,Ivan Pavlov,Yonatan Perez,Oriol Roca,Elsa Tavernier,Bairbre McNicholas,David L Vines,M Marín-Rosales,Alexandra Vargas-Obieta,Roxana García-Salcido,Sara A. Aguirre-Diaz,José A López-Pulgarín,Quetzalcoatl Chavez-Peña,Julio C Mijangos-Méndez,Guadalupe Aguirre-Avalos,Stephan Ehrmann,John G. Laffey +17 more
TL;DR: In this paper , a multicenter randomized controlled trial was conducted in three high-acuity units, where patients with COVID-19-induced acute hypoxemic respiratory failure (AHRF) requiring high-flow nasal cannula (HFNC) oxygen to APP or standard care.
Journal ArticleDOI
Very late intubation in COVID-19 patients: a forgotten prognosis factor?
Laurent Camous,Jean-David Pommier,Frédéric Martino,Benoit Tressières,Alexandre Demoule,Marc Valette +5 more
TL;DR: In this article , the authors describe a COVID 19 patients hospitalized in ICU in University Hospital of Guadeloupe and outcome according to delay between steroid therapy initiation and mechanical ventilation onset.
Journal ArticleDOI
Venovenous Extracorporeal Membrane Oxygenation in Awake Non-Intubated Patients With COVID-19 ARDS at High Risk for Barotrauma
Gianluca Paternoster,Pietro Bertini,Alessandro Belletti,Giovanni Landoni,S. Gallotta,Diego Palumbo,Alessandro Isirdi,Fabio Guarracino +7 more
TL;DR: V-ECMO in awake and spontaneously breathing patients with severe COVID-19 ARDS may be a feasible and safe strategy to prevent the development of PNX/PMD in patients at high risk for this complication.
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TL;DR: In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers, and adequacy of PPE, clinical setting, and ethnic background were also important factors.
Journal ArticleDOI
Ventilator-Induced Lung Injury
TL;DR: The probable causes of mechanical ventilation injury and ways to prevent it are reviewed.