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Invasive Mechanical Ventilation in COVID-19

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COVID-19 Critical and Intensive Care Medicine Essentials

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Abstract

Patients with severe COVID-19 pneumonia present with severe hypoxemic respiratory failure, typically meet the clinical criteria for acute respiratory distress syndrome (ARDS) and often require invasive mechanical ventilation. While peculiar pathophysiological aspects deserve discussion to better tailor the mechanical ventilation settings in these patients, most recommendations on the ventilatory management of these patients are derived from studies in patients with ARDS from causes other than COVID-19. Protective ventilation is recommended in most COVID-19 patients, tidal volume should be kept around 6 mL per kg of predicted body weight, positive end-expiratory pressure (PEEP) should be titrated individually considering that in many patients with COVID-19 improvement of oxygenation at higher PEEP is often accompanied by worsening of respiratory system compliance. Therefore, attention should be paid in limiting plateau and driving pressures to avoid excessive strain potentially resulting in ventilator-induced lung injury. Prone positioning has been used extensively in COVID-19 patients, but its impact on mortality is uncertain. Inhaled nitric oxide, extracorporeal CO2 removal (ECCO2R), and extracorporeal membrane oxygenation (ECMO) should be considered in selected patients as rescue measures.

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Authors and Affiliations

  1. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy

    Andrea Berardino & Lorenzo Ball

  2. Anesthesia and Intensive Care, Ospedale Policlinico San Martino, IRCCS per l’Oncologia e le Neuroscienze, Genoa, Italy

    Lorenzo Ball

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  1. Andrea Berardino
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  2. Lorenzo Ball
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Correspondence to Lorenzo Ball .

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Editors and Affiliations

  1. Anesthesia and Critical Care Unit, Ospedale San Martino, Genova, Italy

    Denise Battaglini

  2. Anesthesia and Critical Care, Ospedale San Martino, Genoa, Italy

    Paolo Pelosi

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Berardino, A., Ball, L. (2022). Invasive Mechanical Ventilation in COVID-19. In: Battaglini, D., Pelosi, P. (eds) COVID-19 Critical and Intensive Care Medicine Essentials. Springer, Cham. https://doi.org/10.1007/978-3-030-94992-1_6

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  • DOI: https://doi.org/10.1007/978-3-030-94992-1_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94991-4

  • Online ISBN: 978-3-030-94992-1

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