Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2

Abstract

The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen therapy was crucial. In this article, we discuss tracheal intubation to provide mechanical ventilation in patients with hypoxaemic acute respiratory failure due to SARS-CoV-2. We first describe the pathophysiology of respiratory anomalies leading to acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2, and then briefly review management, focusing particularly on the ventilation strategy. Overall, the ventilatory management of ARDS due to SARS-CoV-2 infection is largely the same as that applied in ARDS from other causes, and lung-protective ventilation is recommended. The difference lies in the initial clinical presentation, with profound hypoxaemia often observed concomitantly with near-normal pulmonary compliance.

Keywords: COVID-19; ICU; SARS-CoV-2; acute respiratory distress syndrome; management.

Figure 1

Proposed algorithm for a personalized ventilation strategy. ARDS, acute respiratory distress syndrome; L/H, low/high elastance; r/i ratio, recruitment to inflation ratio; ECMO, extracorporeal membrane oxygenation.