• Am J Emerg Med · Oct 2020

    Review

    Initial emergency department mechanical ventilation strategies for COVID-19 hypoxemic respiratory failure and ARDS.

    • Skyler Lentz, Matthew A Roginski, Tim Montrief, Mark Ramzy, Michael Gottlieb, and Brit Long.
    • Division of Emergency Medicine, Department of Surgery, The University of Vermont Larner College of Medicine, USA.
    • Am J Emerg Med. 2020 Oct 1; 38 (10): 219422022194-2202.

    IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging viral pathogen that causes the novel coronavirus disease of 2019 (COVID-19) and may result in hypoxemic respiratory failure necessitating invasive mechanical ventilation in the most severe cases.ObjectiveThis narrative review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.DiscussionIn severe cases, COVID-19 leads to hypoxemic respiratory failure that may meet criteria for acute respiratory distress syndrome (ARDS). The mainstay of treatment for ARDS includes a lung protective ventilation strategy with low tidal volumes (4-8 mL/kg predicted body weight), adequate positive end-expiratory pressure (PEEP), and maintaining a plateau pressure of < 30 cm H2O. While further COVID-19 specific studies are needed, current management should focus on supportive care, preventing further lung injury from mechanical ventilation, and treating the underlying cause.ConclusionsThis review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.Published by Elsevier Inc.

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