Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Abstract

The ongoing novel coronavirus disease pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning.The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive endexpiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients.

ICU and ventilator mortality among critically ill adults with COVID-19

“…4 Taken together, these reports have raised concerns that survival among those receiving mechanical ventilation is exceedingly poor. [11][12][13][14]17 In contrast to the majority of prior reports, our data provide evidence that mortality rates in COVID-19 can be comparable to those seen with ARDS and other infectious pneumonias. [7][8][9][10] In our cohort, mortality was associated with older age, with 30.1% mortality in those age 65 and above as compared to 9.1% in those under age 55.…”

“…[7][8][9][10] These high mortality rates have raised concerns as to whether invasive mechanical ventilation should be avoided in the context of COVID-19. [11][12][13][14] To help address the growing concern that critical illness, and specifically mechanical ventilation, are associated with a high risk of death, we conducted a retrospective cohort study of critically ill patients with COVID-19 across our academic health system.…”

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

“…Regional differences also imply the need for exible region-speci c treatment protocols especially in resource-limited settings [65] instead of the aim to set uniform international protocols for treatment.…”

Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany

“…Complications during ICU stay were: septic shock (40%, n=90), heart failure (8%, n=17) and pulmonary embolism (6%, n=14). Length of ICU-stay was median 13 days ( [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ), duration of MV was 15 days ( [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ). ICU-mortality was 35% (n=78) and 44% (n=74) among patients with MV.…”