Leone Paolo Maria, Siciliano Matteo, Simonetti Jacopo, Lopez Angelena, Zaman Tanzira, Varone Francesco, Richeldi Luca
Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
Università Cattolica del Sacro Cuore, Rome, Italy.
Adv Exp Med Biol. 2021;1318:469-483. doi: 10.1007/978-3-030-63761-3_27.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the novel coronavirus disease 2019 (COVID-19) pandemic, which spread throughout the world. Acute hypoxemic respiratory failure is the most dangerous complication of COVID-19 pneumonia. To date, no specific therapeutic drugs or vaccines have been proven efficacious. Ventilatory support is still a significant challenge for physicians facing COVID-19. The mechanisms underlying hypoxemia in those patients are not fully understood, but a new physiopathology model has been proposed. Oxygen therapy should be delivered to patients with mild to moderate hypoxemia. More severe patients could benefit from other treatments (high-flow nasal cannula, noninvasive ventilation or intubation, and invasive ventilation). Given the rapid evolution of COVID-19, there has been a paucity of the high-quality data that typically inform clinical practice guidelines from professional societies, and a worldwide consensus is still lacking. This chapter aims to illustrate the potentials of ventilatory support as therapeutic options for adult and pediatric patients affected by COVID-19 pneumonia.
严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引发了2019年新型冠状病毒病(COVID-19)大流行,该病在全球范围内传播。急性低氧性呼吸衰竭是COVID-19肺炎最危险的并发症。迄今为止,尚无经证实有效的特异性治疗药物或疫苗。对于面对COVID-19的医生而言,通气支持仍是一项重大挑战。这些患者低氧血症的潜在机制尚未完全明确,但已提出一种新的病理生理学模型。应给予轻度至中度低氧血症患者氧疗。病情更严重的患者可能会从其他治疗(高流量鼻导管吸氧、无创通气或插管以及有创通气)中获益。鉴于COVID-19的快速演变,缺乏通常为专业学会临床实践指南提供依据的高质量数据,且全球仍未达成共识。本章旨在阐述通气支持作为受COVID-19肺炎影响的成人和儿童患者治疗选择的潜力。