Prone positioning in COVID-19 ARDS: more pros than cons

Battaglini, Denise; Pelosi, Paolo; Rocco, Patricia R. M.

doi:10.36416/1806-3756/e20220065

Cited by 1 publication

(3 citation statements)

References 38 publications

(20 reference statements)

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“…Patients with COVID-19 who have an indication for MV need to be protectively ventilated to prevent VILI. For this, a plateau pressure (P plat ) <30 cmH 2 O, driving pressure (ΔP) <15 cmH 2 O, and V T between 6 and 8 mL/kg of PBW are recommended (59). However, within the pathophysiology of COVID-19, the patient may have poorly or non-ventilated lung areas, mainly in the basal and dorsal regions, in contrast to great aeration in the ventral regions, leading to hyperinflation (8).…”

Section: Prone Positionmentioning

confidence: 99%

“…On returning to supine position, some patients may experience a decrease and loss of oxygenation gain (59,72), further favoring extended PP. Recently, the retrospective study by Okin et al ( 72) compared 267 patients with a mean age of 62 years who were subjected to 16 h and 24 h of PP in terms of mortality; 157 patients underwent extended PP (>24 h) and 110 underwent conventional PP (up to 16 h).…”

Section: Duration Of Ppmentioning

confidence: 99%

“…The use of EIT during ARM and PEEP titration may guarantee the most adequate value for the patient, which may be two values below or above the values suggested by the PEEP table (75,81). EIT shows the percentage of well-ventilated, poorly ventilated, collapsed, and hyperinflated areas; the latter two are of interest to the professional at the bedside to avoid VILI (49,59).…”

Section: Arm and Obese Patientsmentioning

confidence: 99%

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New and personalized ventilatory strategies in patients with COVID-19

et al. 2023

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Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus and may lead to severe respiratory failure and the need for mechanical ventilation (MV). At hospital admission, patients can present with severe hypoxemia and dyspnea requiring increasingly aggressive MV strategies according to the clinical severity: noninvasive respiratory support (NRS), MV, and the use of rescue strategies such as extracorporeal membrane oxygenation (ECMO). Among NRS strategies, new tools have been adopted for critically ill patients, with advantages and disadvantages that need to be further elucidated. Advances in the field of lung imaging have allowed better understanding of the disease, not only the pathophysiology of COVID-19 but also the consequences of ventilatory strategies. In cases of refractory hypoxemia, the use of ECMO has been advocated and knowledge on handling and how to personalize strategies have increased during the pandemic. The aims of the present review are to: (1) discuss the evidence on different devices and strategies under NRS; (2) discuss new and personalized management under MV based on the pathophysiology of COVID-19; and (3) contextualize the use of rescue strategies such as ECMO in critically ill patients with COVID-19.

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Section: Prone Positionmentioning

confidence: 99%

Section: Duration Of Ppmentioning

confidence: 99%