Gandhi Kejal D, Sharma Munish, Taweesedt Pahnwat Tonya, Surani Salim
Department of Medicine, Georgetown University/Medstar Washington Hospital Center, Washigton, DC 20010, United States.
Department of Medicine, Corpus Christi Medical Center, Corpus Christi, TX 78412, United States.
World J Crit Care Med. 2021 Sep 9;10(5):183-193. doi: 10.5492/wjccm.v10.i5.183.
The novel coronavirus, which was declared a pandemic by the World Health Organization in early 2020 has brought with itself major morbidity and mortality. It has increased hospital occupancy, heralded economic turmoil, and the rapid transmission and community spread have added to the burden of the virus. Most of the patients are admitted to the intensive care unit (ICU) for acute hypoxic respiratory failure often secondary to acute respiratory distress syndrome (ARDS). Based on the limited data available, there have been different opinions about the respiratory mechanics of the ARDS caused by coronavirus disease 2019 (COVID-19). Our article provides an insight into COVID-19 pathophysiology and how it differs from typical ARDS. Based on these differences, our article explains the different approach to ventilation in COVID-19 ARDS compared to typical ARDS. We critically analyze the role of positive end-expiratory pressure (PEEP) and proning in the ICU patients. Through the limited data and clinical experience are available, we believe that early proning in COVID-19 patients improves oxygenation and optimal PEEP should be titrated based on individual lung compliance.
2020年初被世界卫生组织宣布为大流行病的新型冠状病毒带来了严重的发病率和死亡率。它增加了医院的床位占用率，引发了经济动荡，其快速传播和社区传播加重了病毒负担。大多数患者因急性低氧性呼吸衰竭（常继发于急性呼吸窘迫综合征（ARDS））而入住重症监护病房（ICU）。基于现有的有限数据，对于2019冠状病毒病（COVID-19）所致ARDS的呼吸力学存在不同观点。我们的文章深入探讨了COVID-19的病理生理学及其与典型ARDS的不同之处。基于这些差异，我们的文章解释了与典型ARDS相比，COVID-19 ARDS通气的不同方法。我们批判性地分析了呼气末正压（PEEP）和俯卧位在ICU患者中的作用。尽管现有数据和临床经验有限，但我们认为COVID-19患者早期采用俯卧位可改善氧合，应根据个体肺顺应性滴定最佳PEEP。
