Ventilation management in acute respiratory failure related to COVID-19 versus ARDS from another origin – a descriptive narrative review

ABSTRACT

Introduction

It is uncertain whether ventilation in patients with acute respiratory failure related to coronavirus disease 2019 (COVID-19) differs from that in patients with acute respiratory distress syndrome (ARDS) from another origin.

Areas covered

We undertook two literature searches in PubMed to identify observational studies reporting on ventilation management––one in patients with acute respiratory failure related to COVID-19, and one in patients with ARDS from another origin. The searches identified 14 studies in patients with acute respiratory failure related to COVID-19, and 8 studies in patients with ARDS from another origin.

Expert opinion

In patients with acute respiratory failure related to COVID-19, ventilation management seems to be similar to that of patients with ARDS from another origin. The future lies in studies focused on personalized treatment of ARDS of all origins, including COVID-19.

KEYWORDS:

• Acute respiratory distress syndrome
• acute respiratory failure
• coronavirus disease 2019
• COVID-19
• invasive ventilation
• oxygen fraction
• peep
• prone positioning
• tidal volume
• ventilation management

Article highlights

• Key components of lung-protective ventilation in ARDS patients include limitation of volumes and pressures, prevention of atelectasis while avoiding overdistension, proper use of prone positioning, and use of conservative oxygenation targets;

• PEEP and FiO₂ titrations remain debated in ventilated critically ill patients;

• Lower V_T are used in patients with acute respiratory failure due to COVID-19 than in ARDS of other origin;

• Higher PEEP with broad variation is currently used in COVID-19 patients;

• Higher FiO₂ is needed in COVID-19 patients;

• Prone positioning is used much more often patients with acute respiratory failure due to COVID-19 than in ARDS of other origin;

• It is unclear whether differences in ventilation management between patients with acute respiratory failure due to COVID-19 and in ARDS of other origin reflect protocol adherence or are the consequence of differences in pathophysiology; and

• There are no arguments to ventilate COVID-19 patients different from patients with ARDS of other origin.

Declaration of interest

A. Serpa Neto has received personal fees from Drager, outside of the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.