Ventilatory Management Strategies For Acute Respiratory Distress Syndrome (Ards) Due To Covid-19 Disease
Acute Respiratory Distress Syndrome (ARDS) is a life-threatening diffuse inflammatory condition in the lungs and result in the oxygen treatment-refractory hypoxemic respiratory failure. ARDS is not a disease and is the result or complication of an underlying disease. COVID-19 pneumonia-related ARDS is a specific condition with unique phenotypes. Although patients had very severe hypoxemia in the early stages of respiratory distress due to COVID-19 disease, there was relatively well-preserved lung compliance. This phenotype is named as “atypical ARDS” or “ARDS type L”. In advanced stage, some patients (20-30%) can return to a clinical picture more characteristic of typical ARDS progressively. This phenotype is called "typical ARDS" or "ARDS type H". Different types of ARDS that develop due to COVID-19 pneumonia require different ventilation strategies, depending on the underlying pathophysiology. In patients with early-stage atypical ARDS phenotype higher TVs and lower PEEP may be preferred, as opposed to the lung protective mechanical ventilator strategy. Nowadays, in the typical ARDS phenotype, the lung protective ventilation strategy used in classical ARDS is widely preferred. Refractory patients (a small number of patients) need to additional applications which are including prone ventilation and exorcoral membrane oxygenation (ECMO).
Keywords: Covid-19 disease, ARDS, Ventilatory management strategies, Prone ventilation, ECMO
Eurasian J Critical Care 2020; 2 (2):171-182 EJCC