By Dr Federico Formenti, Kings College London, UK; Dr John N. Cronin, King College London, UK (@John_n_Cronin); Dr Luigi Camporota, Guy’s and St Thomas’ NHS Foundation Trust, UK (@Luigi_ICM)
To improve the safety of mechanical ventilation in COVID-19 patients in intensive care units, it must provide the patient with enough oxygen to survive, but air pressures must be set so that the lung is not excessively stretched.
That’s according to our new review paper published in The Physiological Society’s journal Experimental Physiology this week.
SARS-CoV-2 infection can lead to COVID-19 inflammation in the lung, which may require mechanical ventilation in the most severe cases.
Spreading in the United Kingdom in early 2020, COVID-19 presented as a new form of respiratory disease where some, but not all features of the disease are shared with other forms of acute respiratory failure.
While mechanical ventilation is not a cure for the disease, it may be necessary to sustain life in the acute phase of the disease until the disordered interaction between the virus and the patient’s immune and coagulation systems – which causes organ dysfunction – returns to normal.
To make mechanical ventilation more safe, it must be done in a way that provides the patient with sufficient oxygen levels to survive, but the air pressures used must be based on the characteristics of the patient’s lungs to avoid excessive stretching, and to prevent injuring the lung further.
Our new study is important because it presents a critical analysis of the vast literature in the field of mechanical ventilation in COVID-19 patients, providing a way to improve this technique by tailoring it to the patient’s lungs.
In addition, the study is not just theoretical, but was informed by the research team’s experience in caring for COVID-19 patients in intensive care at Guy’s and St Thomas’ NHS Foundation Trust using mechanical ventilation and extracorporeal membrane oxygenation (ECMO), and achieving the highest survival rates in the UK.
The combination of strong research and direct application of physiological principles to clinical practice have allowed the study to present the basis for new criteria for safe and effective mechanical ventilation strategies, and how these can be tailored to the individual patient level.
We are excited that our analysis proposes new criteria for the management of mechanical ventilation for COVID-19 patients in the intensive care unit. These criteria have not been studied in a clinical trial yet; their potential effectiveness is expected based on the evidence available at the time of this research and a strong physiological rationale.
In other words, our study provides the basis for clinical trials where the settings of mechanical ventilation can be tailored to the individual patient level, based on their respiratory system mechanics and function. If successful, these trials could provide the basis for new approaches to mechanical ventilation in COVID-19 patients, which may be applied more widely to other patients with acute respiratory failure.
References
- Full paper title: Mechanical ventilation in COVID-19: A physiological perspective; Link to paper https://physoc.onlinelibrary.wiley.com/doi/abs/10.1113/EP089400
- A related viewpoint article based on this review paper: Should we treat COVID-19 lung injury like ARDS?: Exploring the paradigm https://physoc.onlinelibrary.wiley.com/doi/10.1113/EP090010