How is acute respiratory distress syndrome (ARDS) managed in patients with critical coronavirus disease 2019 (COVID-19)?

Updated: Jul 01, 2020
  • Author: Medscape Drugs & Diseases; more...
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Answer

Severe hypoxemic respiratory failure must be recognized when standard oxygen therapy is failing in a patient with respiratory distress; prepare for administration of advanced oxygen/ventilatory support. [4]

Prone ventilation for 12-16 hours per day is recommended in adult mechanically ventilated patients with refractory hypoxemia despite optimized ventilation. [4]

Oxygenation for severe ARDS:

  • Adult: PaO 2/FiO 2 ≤100 mm Hg with PEEP ≥5 cm H 20 or nonventilated (When PaO 2 is not available, SpO 2/FiO 2 ≤315 suggests ARDS)
  • Child: OI ≥16 or OSI ≥12.3

Corticosteroids are not routinely recommended for viral pneumonia or acute respiratory distress syndrome (ARDS) and should be avoided unless indicated for another reason (eg, COPD exacerbation, refractory septic shock). Nonetheless, The UK RECOVERY trial showed that low-dose dexamethasone (6 mg PO or IV daily for 10 days) randomized to 2104 patients reduced deaths by 35% in ventilated patients (P = 0.0003) and by 20% in other patients receiving oxygen only (P = 0.0021) compared with patients who received standard of care (n = 4321). No benefit was seen in patients who did not require respiratory intervention (P = 0.14). [11]


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