The use of positive end expiratory pressure in patients affected by COVID-19: Time to reconsider the relation between morphology and physiology

Perchiazzi, Gaetano; Pellegrini, Mariangela; Chiodaroli, Elena; Urits, Ivan; Kaye, Alan D.; Viswanath, Omar; Varrassi, Giustino; Puntillo, Filomena

doi:10.1016/j.bpa.2020.07.007

Cited by 7 publications

(6 citation statements)

References 42 publications

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“…In contrast, if atelectasis is present and static compliance is low, in our opinion, moderate PEEP levels (12–15 cmH2O) can be useful to improve lung recruitment; nevertheless, it is important to avoid overdistention and hemodynamic instability [ 7 ]. Although no definitive evidence exists regarding the ventilatory strategies to be applied in these patients, authors suggest using lung protective ventilation with tidal volumes ≤6 mL/kg of predicted body weight, driving pressure ≤15 cmH2O, and individualized PEEP titration based on clinical presentation, chest CT scan, and respiratory mechanics [ 32 , 33 ]. Recruitment maneuvers may be considered as a rescue therapy in case of hypoxemia despite optimizing ventilation [ 34 ].…”

Section: Introductionmentioning

confidence: 99%

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Robba

Battaglini

Ball

et al. 2021

Expert Review of Respiratory Medicine

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Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide. Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature. Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.

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Section: Introductionmentioning

confidence: 99%

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Robba

Battaglini

Ball

et al. 2021

Expert Review of Respiratory Medicine

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“…The novel coronavirus outbreak of 2019-2020 resulting in the potentially life-threatening disease of COVID-19 is going on at the time of writing this article [18]. This fourth pandemic of the past 100 years, among other issues [19][20][21][22][23][24] has exposed a pretty new problem for public health: misleading or false information. COVID-19 and the Spanish flu share some similar features: both diseases are highly contagious and both outbreaks occurred in an era when people left home: the Spanish flu during a world war and COVID-19 in an era of globalization.…”

Section: Covid-19mentioning

confidence: 99%

Four pandemics: lessons learned, lessons lost

et al. 2020

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In the past 100 years, the world has faced four distinctly different pandemics: the Spanish flu of 1918-1919, the SARS pandemic of 2003, the H1N1 or “swine flu” pandemic of 2012, and the ongoing COVID-19 pandemic. Each public health crisis exposed specific systemic shortfalls and provided public health lessons for future events. The Spanish flu revealed a nursing shortage and led to a great appreciation of nursing as a profession. SARS showed the importance of having frontline clinicians be able to work with regulators and those producing guidelines. H1N1 raised questions about the nature of a global organization such as the World Health Organization in terms of the benefits and potential disadvantages of leading the fight against a long-term global public health threat. In the era of COVID-19, it seems apparent that we are learning about both the blessing and curse of social media.

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“…The common clinical presentations of the disease caused by COVID-19 are fever (98%), cough (76%), myalgia and fatigue (18% each), with accompanying leucopenia (25%) and lymphopenia (63%) [5][6][7]. Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19, evidence is emerging that the involvement of other organs and tissues are of pivotal importance [8]. Ongoing reports describe the hyper-coagulability and thrombotic tendency in COVID-19, as well as the damage to endothelium and the activation of inflammation leading to vasculitis [9,10].…”

Section: Introductionmentioning

confidence: 99%

Successful Spinal Cord Stimulation for Necrotizing Raynaud’s Phenomenon in COVID-19 Affected Patient: The Nightmare Comes Back

Giglio¹,

Preziosa²,

Rekatsina³

et al. 2021

Cureus

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Necrotizing Raynaud's phenomenon is a vascular clinical syndrome characterized by vasospasm of distal resistance vessels, usually triggered by cold temperatures or by psychological conditions such as anxiety and stress. Pain is the first reported symptom, related to insufficient oxygen delivery to the extremities that leads to ischemia of the peripheral tissues. The initial treatment is conservative, but if the symptoms persist, necrosis and distal amputation can occur. In selected patients, neuromodulation with spinal cord stimulation (SCS) can be an effective treatment by reducing pain and amputation rate. Recent evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause endotheliopathy with microvascular and macrovascular thrombotic events and can present as a systemic inflammatory vascular disease.We present a case of a severe necrotizing Raynaud's phenomenon successfully treated and controlled with SCS that abruptly reappeared during SARS-CoV-2 infection.The report of this case is suggestive for potential treatment in case of peripheral ischemia consequent to COVID-19 vasculopathy. The interaction between SCS and SARS-CoV-2-related endotheliopathy is unknown and would deserve further studies.

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The use of positive end expiratory pressure in patients affected by COVID-19: Time to reconsider the relation between morphology and physiology

Cited by 7 publications

References 42 publications

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Four pandemics: lessons learned, lessons lost

Successful Spinal Cord Stimulation for Necrotizing Raynaud’s Phenomenon in COVID-19 Affected Patient: The Nightmare Comes Back

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