Late Breaking Abstract - High volume, low PEEP and passive hyperventilation without sedatives instead of low tidal volume, high PEEP and deep sedation in COVID19

Abstract

COVID 19 is usually considered as ARDS and treated with lung protective ventilation (LP), using early intubation, a low tidal volume, low pressure and high PEEP, but with an unfavourable outcome. Every COVID19 patient, however, experiences dyspnoe and a high ventilatory load. We, therefore used a ventilatory unloading strategy (VU) to meet these complaints. <b>Method:</b> The first 6 patients, showing severe COVID19, 2 on noninvasive ventilation (NIV) and 4 already intubated and transferred from France after LP and prone positoning, were treated with a high pressure and low PEEP to reach a high tidal volume, to supress their respiratory drive (table 1). <b>Results:</b> In 2 patients intubation was avoided. In the intubated, sedatives and catecholamines could be withdrawn the same day. 1 was extubated after 20 hours, another after 2 days, 2 remained on intermittent ventilation and T piece breathing until recovery from deep sedation. Severe patchy and solid infitrates in all lobes resolved in 4, but persisted in 2 until discharge. Lung function and blood gases had normalized in 4 and improved in 2. Nobody died. <b>Conclusions:</b> Our COVID19 patients were successfully treated with high tidal volumes to relieve their dyspnoe. PEEP was kept low to limit pressures. Little sedatives were needed allowing to avoid intubation, to extubate early and to stabilize until recovery from sedation. Lung function and radiology improved with no sign of ventilatory induced lung injury.