COVID-19 ARDS: Points to Be Considered in Mechanical Ventilation and Weaning

Eumorfia Kondili; Demosthenes Makris; Dimitrios Georgopoulos; Nikoletta Rovina; Anastasia Kotanidou; Antonia Koutsoukou

doi:10.3390/jpm11111109

COVID-19 ARDS: Points to Be Considered in Mechanical Ventilation and Weaning

J Pers Med. 2021 Oct 28;11(11):1109. doi: 10.3390/jpm11111109.

Authors

Eumorfia Kondili¹, Demosthenes Makris², Dimitrios Georgopoulos¹, Nikoletta Rovina³, Anastasia Kotanidou⁴, Antonia Koutsoukou³

Affiliations

¹ Department of Intensive Care Medicine, University Hospital of Heraklion and Medical School, University of Crete, 71110 Heraklion, Greece.
² Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece.
³ 1st Department of Respiratory Medicine, Medical School, "Sotiria" Chest Disease Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece.
⁴ 1st Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National & Kapodistrian "Evangelismos" Hospital, University of Athens, 10676 Athens, Greece.

Abstract

The COVID-19 disease can cause hypoxemic respiratory failure due to ARDS, requiring invasive mechanical ventilation. Although early studies reported that COVID-19-associated ARDS has distinctive features from ARDS of other causes, recent observational studies have demonstrated that ARDS related to COVID-19 shares common clinical characteristics and respiratory system mechanics with ARDS of other origins. Therefore, mechanical ventilation in these patients should be based on strategies aiming to mitigate ventilator-induced lung injury. Assisted mechanical ventilation should be applied early in the course of mechanical ventilation by considering evaluation and minimizing factors associated with patient-inflicted lung injury. Extracorporeal membrane oxygenation should be considered in selected patients with refractory hypoxia not responding to conventional ventilation strategies. This review highlights the current and evolving practice in managing mechanically ventilated patients with ARDS related to COVID-19.

Keywords: COVID-19; lung injury; mechanical ventilation; weaning.

Publication types

Review