Personalisation of Therapies in COVID-19 Associated Acute Respiratory Distress Syndrome, Using Electrical Impedance Tomography.

Atsuko Shono,Inéz Frerichs,Toru Kotani

doi:10.2478/jccm-2020-0045

Abstract

IntroductionEach patient suffering from severe coronavirus COVID-19-associated acute respiratory distress syndrome (ARDS), requiring mechanical ventilation, shows different lung mechanics and disease evolution. Therefore, lung protective strategies should be personalised for the individual patient.Case presentationA 64-year-old male patient was intubated ten days after the symptoms of COVID-19 infection presented. He was placed in the prone position for sixteen hours, resulting in a marked improvement in oxygenation. However, after being returned to the supine position, his SpO2 rapidly dropped from 98% to 91%, and electrical impedance tomography showed less ventilation at the dorsal region and a ventral shift of ventilation distribution. An incremental and decremental PEEP trial under electrical impedance tomography monitoring was carried out, confirming that the dependent lung regions were recruited with increased pressures and homogenous ventilation distribution could be provided with 14 cmH2O of PEEP. The optimal settings were reassessed next day after returning from the second session of the prone position. After four prone position-sessions in five days, oxygenation was stabilised and eventually the patient was discharged.ConclusionsPatients with COVID-19 associated ARDS require individualised ventilation support depending on the stage of their disease. Daily PEEP trial monitored by electrical impedance tomography can provide important information to tailor the respiratory therapies.

Highlights

Each patient suffering from severe coronavirus COVID-19-associated acute respiratory distress syndrome (ARDS), requiring mechanical ventilation, shows different lung mechanics and disease evolution
The current recommendations are to follow the concept and strategies suggested for the management of acute respiratory distress syndrome (ARDS)
Different lung mechanics and disease evolution make patient management difficult when COVID-19 pneumonia presents with concomitant respiratory failure

Summary

Introduction

The coronavirus disease 2019 (COVID-19) has emerged as a cause of acute respiratory failure worldwide. Available online at: www.jccm.ro pressure (PEEP) trials using electrical impedance tomography, after returning to the supine position from the prone position. Available online at: www.jccm.ro as an appropriate level and an inspiratory pressure of 28 cmH2O, allowed the maintenance of a tidal volume of 6–7 ml/kg/predicted body weight. On Day 2, post-admission to the ICU, the patient was placed in the prone position for sixteen hours without a change in the ventilatory settings. On Day 5 post-admission to the ICU, the more homogeneous distribution of ventilation was maintained by a previously selected inspiratory pressure of 28 cmH2O and PEEP of 15 cmH2O. On ICU Day 8, the patient was transferred to the peripheral hospital, where he showed further improvement

Discussion

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Conclusions