Managing Severe Hypoxic Respiratory Failure in COVID-19

Abstract

Purpose of Review Adult respiratory distress syndrome is a life-threatening complication from severe COVID-19 infection resulting in severe hypoxic respiratory failure. Strategies at improving oxygenation have evolved over the course of the pandemic. Recent Findings Although non-invasive respiratory support reduces the need for intubation, a significant number of patients with COVID-19 progress to invasive mechanical ventilation. Once intubated, a lung protective ventilation strategy should be employed that limits tidal volumes to 6 ml/kg of predicted body weight and employs sufficient positive end-expiratory pressure to maximize oxygen delivery while minimizing the fraction of inspired oxygen. Intermittent prone positioning is effective at improving survival, and there is a growing body of evidence that it can be safely performed in spontaneously breathing patients to reduce the need for invasive mechanical ventilation. Inhaled pulmonary vasodilators have not been shown to improve survival or cost-effectiveness in COVID-19 and should be used selectively. Summary Finally, the best outcomes are likely achieved at centers with experience at severe ARDS management and protocols for escalation of care.

Does apneic oxygenation with nasopharyngeal cannula during intubation improve the oxygenation in patients with acute hypoxemic respiratory failure compared to the standard bag valve mask preoxygenation? An open-labeled randomized control trial

“…This patient group typically exhibits compromised lung function, and crucial information such as the duration of disease severity and baseline SpO 2 is unknown. [ 24 25 ] Notably, patients were enrolled without prior knowledge of their COVID-19 infectivity status, and their care strictly adhered to evidence-based guidelines while following standard universal precautions. Consequently, no noticeable differences were observed in the management of COVID-19 patients.…”

Deferiprone: A Forty-Year-Old Multi-Targeting Drug with Possible Activity against COVID-19 and Diseases of Similar Symptomatology

“…The major symptoms and cause of mortality in COVID-19 patients are mainly associated with a respiratory syndrome and lung damage, respiratory failure and hypoxia. Seriously ill COVID-19 hypoxic patients have lung damage that causes a low level of ratio of peripheral blood oxygen saturation to fraction of inspired oxygen and if they cannot receive early successful treatment, only about half of the patients can survive with the aid of mechanical ventilation [ 142 , 143 ]. Drugs that can cause inhibition or reduction of the acute respiratory distress syndrome and prevent hypoxia can reduce substantially the rate of morbidity and mortality of COVID-19 patients [ 144 ].…”