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Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings
The ongoing novel coronavirus disease (COVID-19) pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. A...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The American Society of Tropical Medicine and Hygiene
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253105/ https://www.ncbi.nlm.nih.gov/pubmed/32319424 http://dx.doi.org/10.4269/ajtmh.20-0283 |
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author | Dondorp, Arjen M. Hayat, Muhammad Aryal, Diptesh Beane, Abi Schultz, Marcus J. |
author_facet | Dondorp, Arjen M. Hayat, Muhammad Aryal, Diptesh Beane, Abi Schultz, Marcus J. |
author_sort | Dondorp, Arjen M. |
collection | PubMed |
description | The ongoing novel coronavirus disease (COVID-19) pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning. The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive end-expiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients. |
format | Online Article Text |
id | pubmed-7253105 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | The American Society of Tropical Medicine and Hygiene |
record_format | MEDLINE/PubMed |
spelling | pubmed-72531052020-05-31 Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings Dondorp, Arjen M. Hayat, Muhammad Aryal, Diptesh Beane, Abi Schultz, Marcus J. Am J Trop Med Hyg Review Article The ongoing novel coronavirus disease (COVID-19) pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning. The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive end-expiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients. The American Society of Tropical Medicine and Hygiene 2020-06 2020-04-21 /pmc/articles/PMC7253105/ /pubmed/32319424 http://dx.doi.org/10.4269/ajtmh.20-0283 Text en © The American Society of Tropical Medicine and Hygiene This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Review Article Dondorp, Arjen M. Hayat, Muhammad Aryal, Diptesh Beane, Abi Schultz, Marcus J. Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings |
title | Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings |
title_full | Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings |
title_fullStr | Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings |
title_full_unstemmed | Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings |
title_short | Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings |
title_sort | respiratory support in covid-19 patients, with a focus on resource-limited settings |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253105/ https://www.ncbi.nlm.nih.gov/pubmed/32319424 http://dx.doi.org/10.4269/ajtmh.20-0283 |
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