Department of Anesthesiology, Faculty of Medicine, Universitas Methodist Indonesia, Medan, Sumatera Utara, Indonesia.
Anesthesiology Department, Siloam Dhirga Surya Hospital, Medan, Sumatera Utara, Indonesia.
J Med Case Rep. 2022 Dec 27;16(1):486. doi: 10.1186/s13256-022-03658-3.
Coronavirus disease 2019 is a highly transmissible and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2, a novel coronavirus that was identified in early January 2020 in Wuhan, China, and has become a pandemic disease worldwide. The symptoms of coronavirus disease 2019 range from asymptomatic to severe respiratory failure. In moderate and severe cases, oxygen therapy is needed. In severe cases, high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation are needed. Many ventilation methods in mechanical ventilation can be used, but not all are suitable for coronavirus disease 2019 patients. Airway pressure release ventilation, which is one of the mechanical ventilation methods, can be considered for patients with moderate-to-severe acute respiratory distress syndrome. It was found that oxygenation in the airway pressure release ventilation method was better than in the conventional method. How about airway pressure release ventilation in coronavirus disease 2019 patients? We report a case of confirmed coronavirus disease 2019 in which airway pressure release ventilation mode was used.
In this case study, we report a 74-year-old Chinese with a history of hypertension and uncontrolled diabetes mellitus type 2. He came to our hospital with the chief complaint of difficulty in breathing. He was fully awake with an oxygen saturation of 82% on room air. The patient was admitted and diagnosed with severe coronavirus disease 2019, and he was given a nonrebreathing mask at 15 L per minute, and oxygen saturation went back to 95%. After a few hours with a nonrebreathing mask, his condition worsened. On the third day after admission, saturation went down despite using noninvasive ventilation. We decided to intubate the patient and used airway pressure release ventilation mode. Finally, after 14 days of being intubated, the patient could be extubated and discharged after 45 days of hospitalization.
Early use of airway pressure release ventilation may be considered as one of the ventilation strategies to treat severe coronavirus disease 2019 acute respiratory distress syndrome. Although reports on airway pressure release ventilation and protocols on its initiation and titration methods are limited, it may be worthwhile to consider, given its known ability to maximize alveolar recruitment, preserve alveolar epithelial integrity, and surfactant, all of which are crucial for handling the "fragile" lungs of coronavirus disease 2019 patients.
新型冠状病毒病（COVID-19）是一种由严重急性呼吸综合征冠状病毒 2（一种新型冠状病毒）引起的高传染性和高致病性病毒感染。这种新型冠状病毒于 2020 年 1 月在中国武汉首次被发现，并已在全球范围内成为一种大流行疾病。COVID-19 的症状从无症状到严重呼吸衰竭不等。在中度和重度病例中需要氧疗。在严重的情况下，需要使用高流量鼻导管、无创通气和有创机械通气。机械通气中有许多通气方法可以使用，但并非所有方法都适用于 COVID-19 患者。气道压力释放通气是机械通气方法之一，可考虑用于中重度急性呼吸窘迫综合征患者。研究发现，气道压力释放通气方法的氧合效果优于常规方法。那么，气道压力释放通气在 COVID-19 患者中的效果如何呢？我们报告了一例确诊的 COVID-19 患者，该患者使用了气道压力释放通气模式。
在本病例研究中，我们报告了一例 74 岁的中国男性，有高血压和 2 型糖尿病未控制的病史。他因呼吸困难就诊，完全清醒，在空气环境下的氧饱和度为 82%。患者入院后被诊断为严重 COVID-19，给予 15 升/分钟的无重复呼吸面罩，氧饱和度回升至 95%。使用无重复呼吸面罩几个小时后，病情恶化。入院第三天，即使使用无创通气，饱和度仍下降。我们决定对患者进行插管，并使用气道压力释放通气模式。最终，在插管 14 天后，患者可以拔管，住院 45 天后出院。
早期使用气道压力释放通气可能被视为治疗严重 COVID-19 急性呼吸窘迫综合征的通气策略之一。尽管关于气道压力释放通气以及其启动和滴定方法的报告有限，但鉴于其已知能够最大限度地增加肺泡募集、保持肺泡上皮完整性和表面活性剂的能力，这对于处理 COVID-19 患者的“脆弱”肺部至关重要，因此考虑使用气道压力释放通气可能是值得的。
