Abstract
The SARS-CoV-2 (COVID-19) pandemic has forced some reflections to be had surrounding the ventilatory support to be applied to certain types of patients. The model of two phenotypes, set out by Professor Gattinoni and colleagues, suggests that adequate monitoring of respiratory effort may play a key role in the treatment of respiratory failure due to COVID-19. An insufficient control of the patient’s respiratory efforts could lead to an aggravation of lung damage, mainly due to the possibility of generating Patient Self-Inflicted Lung Injury (PSILI) with a consequent aggravation of the pathological picture. Nevertheless, effectively monitoring the patient’s respiratory work, especially in nonintensive settings, is not easy. This article briefly describes some methods that allow the assessment of respiratory effort, such as the use of ultrasound and respiratory tests, which can be performed in nonintensive settings.
Highlights
Since the 31 December 2019, when the Chinese authorities informed the WHO of the presence of a cluster of patients with pneumonia of unknown origins [1], it soon became clear that correct respiratory support for COVID-19 patients played a fundamental role in their treatment [2]
After starting to stratify patients into different phenotypes depending on the severity of their clinical and radiological picture [3], it was possible to correlate the patient’s clinical phenotype to disease progression [4], establishing a direct relationship between progression of the clinical phenotype which evolves towards increasingly severe pictures of respiratory failure, and the course of the disease which leads to its inflammatory phase
The modalities of respiratory assistance for the COVID-19 patient have changed [5], and, alongside the need to ensure adequate oxygenation parameters for the patient, more and more attention has been paid to the control of the respiratory drive, even during the phases of noninvasive ventilation (NIV) [6]
Summary
Since the 31 December 2019, when the Chinese authorities informed the WHO of the presence of a cluster of patients with pneumonia of unknown origins [1], it soon became clear that correct respiratory support for COVID-19 patients played a fundamental role in their treatment [2]. The modalities of respiratory assistance for the COVID-19 patient have changed [5], and, alongside the need to ensure adequate oxygenation parameters for the patient, more and more attention has been paid to the control of the respiratory drive, even during the phases of noninvasive ventilation (NIV) [6]. According to this point of intervention, it appears to be clear how the proper monitoring of the patient’s respiratory effort (Work of breathing, WOB), plays a decisive part in assisting this type of patient, in order to substantially minimize the risk of Patient.
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