Ventilation of COVID-19 patients in intensive care units

Excerpt

About 5–15% of patients with COVID(corona virus disease)-19 infection require intensive care surveillance and ventilatory support. Current recommendations suggest early intubation of COVID-19 patients mainly for two reasons: (1) severe hypoxemia with PaO₂/FiO₂ often <200 mm Hg, fulfilling Berlin criteria of moderate-to-severe acute respiratory distress syndrome (ARDS); and (2) to protect staff from viral transmission [1, 2]. Mortality during mechanical ventilation appears to be high, however, and lung-protective ventilation is mandatory. Gattinoni et al. reported that many patients with COVID-19 pneumonia are initially characterized by a relatively well-preserved lung compliance despite severe hypoxemia, which is generally not observed in typical ARDS [3, 4]. Their concept of “L-type” and “H-type” pneumonia was presented at an ESICM webinar on April 2, 2020 [5]. These contributions and current recommendations form the basis of this brief review. …