Recently, several articles have reported that the early acute respiratory distress syndrome (ARDS) caused by coronavirus disease 2019 (COVID-19) significantly differ from those of ARDS due to other causes, such as mismatch between changes in respiratory mechanics and severity of impaired oxygenation, significantly decreased ventilation efficiency, and lower lung recruitability.
As of April 29, 2020, the number of total confirmed cases has exceeded 3 million, associated to 207,973 deaths worldwide. Tidal volume (8–9 ml/kg) could be increased appropriately under the limited plateau pressure however, barotrauma should still be kept in mind.Īn ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally. Conclusionĭuring the recovery period of ARDS among mechanically-ventilated COVID-19 patients, attention should be paid to the monitoring of physiological dead space and metabolism. We found that remarkably decreased ventilatory efficiency (e.g., the ratio of dead space to tidal volume 70–80%, arterial to end-tidal CO 2 difference 18–23 mmHg and ventilatory ratio 3–4) and hypermetabolism (oxygen consumption 300–400 ml/min, CO 2 elimination 200–300 ml/min) may explain why these patients experienced more severe respiratory distress and CO 2 retention in the late phase of ARDS caused by COVID-19. To explain these pathophysiological features and discuss the ventilatory strategy during the late phase of severe ARDS in COVID-19 patients, we first used a metabolic module on a General Electric R860 ventilator (Engstrom Carestation GE Healthcare, USA) to monitor parameters related to gas metabolism, lung mechanics and physiological dead space in two COVID-19 patients. However, the underlying mechanics remain unclear. Actually, we newly observed that some mechanically ventilated COVID-19 patients recovering from severe ARDS (more than 14 days after invasive ventilation) often experienced evidently gradual increases in CO 2 retention and minute ventilation. Recently, several articles have mentioned that the early acute respiratory distress syndrome (ARDS) caused by COVID-19 significantly differ from those of ARDS due to other causes. An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally.
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