What is the role of mechanical ventilation in the treatment of coronavirus disease 2019 (COVID-19)?

Updated: Jan 12, 2021
  • Author: Setu K Patolia, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

Endotracheal intubation in COVID-19 patients is a high-risk procedure. Care must be taken to minimize aerosolization of the virus and protect the healthcare workers present. First, if possible, all intubations should be conducted in negative-pressure rooms. An attempt should be made to minimize bag-mask ventilation, and intubation should be performed by an experienced practitioner using rapid sequence intubation to maximize first-pass intubation. Further, the balloon should be inflated immediately after intubation to prevent further leakage of the virus. [21]

As with other causes of respiratory failure and ARDS, patients intubated secondary to COVID-19 should be treated with lung-protective ventilation with a tidal volume of 6 mL/kg ideal body weight and maintaining the plateau pressure under 30 cm H20. [24] As with ARDS from other causes, the respiratory rate is then increased to maintain minute ventilation. Some groups have also proposed using other nontraditional modes of mechanical ventilation modes such as airway pressure release ventilation.

Further, although no specific evidence exists, higher positive end-expiratory pressure, the use of prone positioning, neuromuscular blockade, inhaled vasodilators, and maintaining a net negative fluid balance of 0.5-1 L/day might improve respiratory failure. [25]


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