[Clinical update in critical care of pulmonary medicine 2021]

Abstract

In this review, we outlined the clinical studies in critical care field of pulmonary medicine from November 1, 2020 to September 30, 2021. A Chinese retrospective study for critically ill patients with COVID-19 showed that corticosteroid therapy was associated with a reduced 28-day mortality in patients with the hyperinflammatory phenotype. In hospitalized patients with COVID-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization, and early sedation with dexmedetomidine exhibited a high probability of reduced 90-day mortality in older patients regardless of operative or non-operative cluster status. High-flow nasal cannula (HFNC) improved the prognosis compared with conventional oxygen therapy in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with acute compensated hypercapnic respiratory failure. For COVID-19 patients suffering from acute respiratory failure with HFNC therapy, awake prone positioning reduces the incidence of treatment failure and the need for intubation. Compared with pressure-volume curve guiding positive end-expiratory pressure (PEEP) titration for acute respiratory distress syndrome (ARDS) patients, PEEP titration guided with EIT (Electrical impedance tomography) might be associated with improved driving pressure and survival rate. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe ARDS patients, but the survival among ECMO-assisted patients with COVID-19 is strongly associated with a centre's experience in ECMO during the previous year and early ECMO management. Compared to conventional lung-protective mechanical ventilation (MV), neurally adjusted ventilatory assist (NAVA) decreased duration of MV. These findings also provide evidence for improving the clinical management in critical care of pulmonary medicine.