Respiratory Pathophysiology of Mechanically Ventilated COVID-19 Patients.

Anas Khalil,Bashayer Alemam,Hind M Alshanqiti,Hayam Albadi,Raghad Almughazzawi,Fardus Alshangiti,Fatmah A Jeddo,Atif Aljohani

doi:10.7759/cureus.20218

Anas Khalil, Bashayer Alemam + Show 6 more

Open Access

https://doi.org/10.7759/cureus.20218

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Journal: Cureus	Publication Date: Dec 6, 2021
License type: cc-by

Affiliation: Taibah University

Abstract

Background and objectivesCoronavirus disease 2019 (COVID-19) is mainly a disease of the respiratory system that can lead to acute respiratory distress syndrome (ARDS). The pathophysiology of COVID-19 ARDS and consequently its management is a disputable subject. Early COVID-19 investigators hypothesized that the pathogenesis of COVID-19 ARDS is different from the usual ARDS. The aim of this study was to describe the lung mechanics in mechanically ventilated COVID-19 patients with ARDS.MethodologyAn observational retrospective cohort study was conducted on adult COVID-19 patients with ARDS who needed mechanical ventilation in the ICU of Ohoud Hospital, Madinah, KSA, from June to September 2020. Data were collected from the patients’ medical charts and electronic medical records and analyzed using Statistical Package for the Social Sciences (SPSS) software package version 22 (IBM Corp., Armonk, NY) for descriptive statistical analysis.Measurements and main resultsA total of 52 patients were analyzed: on intubation, the median positive end-expiratory pressure (PEEP) was 10 cm H2O (IQR, 2.3-16), the median plateau pressure was 27 cm H2O (IQR, 12-40), and the median driving pressure was 17 cm H2O (IQR, 3-30). The median static compliance of the respiratory system was 24.7 mL/cm H2O (IQR, 12.8-153.3). 59.5% had severe ARDS (the PaO2/FiO2 ratio was less than 100 mmHg), and 33% had moderate ARDS (the PaO2/FiO2 ratio ranged from 100 to 200 mmHg).ConclusionOur results suggest that the lung mechanics in COVID-19 ARDS patients who need mechanical ventilation do not differ from non-COVID-19 patients.

Highlights

In late December 2019, an outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged that was later named coronavirus disease 2019 (COVID-19) [1,2]
Our results suggest that the lung mechanics in COVID-19 acute respiratory distress syndrome (ARDS) patients who need mechanical ventilation do not differ from non-COVID-19 patients
We looked into the respiratory pathophysiology of mechanically ventilated COVID-19 patients with acute respiratory distress syndrome at Ohoud Hospital, Madinah, Saudi Arabia

Summary

Introduction

In late December 2019, an outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged that was later named coronavirus disease 2019 (COVID-19) [1,2]. ARDS is an acute lung inflammation that affects both lungs and cause leakage of plasma and blood into the alveoli, leading to non-cardiogenic pulmonary edema. This causes shunt-related hypoxemia, low lung compliance and reduced ventilatable lung parenchyma [6,7]. The treatment of ARDS is focused on improving oxygenation, preventing further lung injury and increasing lung homogeneity [6] This can be achieved by lung recruitment using high positive endexpiratory pressure (PEEP) and prone positioning, low tidal volume ventilation, preventing applying high pressure from the ventilator on the alveoli (plateau pressure) and maintaining patient-ventilatory synchrony. The aim of this study was to describe the lung mechanics in mechanically ventilated COVID-19 patients with ARDS

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