Copyright
©The Author(s) 2021.
World J Crit Care Med. Sep 9, 2021; 10(5): 183-193
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.183
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.183
Gattinoni et al[12] | Tobin et al[17] |
Silent hypoxemia is caused by vasoplegia which increases the respiratory drive and increases the tidal volume, causing negative intrathoracic pressure. Dyspnea is not endorsed in the setting of near-normal respiratory compliance | Silent hypoxemia is caused by underlying physiologic mechanism such as fever causing right shift of oxygen dissociation curve, unreliability of pulse oximeter at SaO2 < 80% and decreased chemoreceptor response to PaO2 < 60 mmHg with normocapnia |
Increased tidal volume causing progressive increase in negative intrathoracic pressure results in P-SILI | P-SILI needs further research and increase in tidal volume is not associated with requiring intubation, whereas, underlying critical condition leads to intubation |
Esophageal manometric measurement of work of breathing is crucial to determine the inspiratory efforts of the patient. Esophageal pressure > 15 is associated with increased risk of lung injury and patient should be intubated as early as possible | No data available to support the arbitrary measurement of esophageal pressure as an indication of intubation. Also, insertion of esophageal balloon in dyspneic COVID-19 patients increases the risk for intubation |
Early intubation is advised along with esophageal manometric measurement of work of breathing | Less liberal use of intubation and mechanical ventilation. Should be used when hypoxia is accompanied with increased work of breathing and severe respiratory distress |
Spontaneous breathing trials should be implemented only at the end of the weaning process as strong spontaneous efforts raise oxygen demand, edema and P-SILI | Weaning and spontaneous breathing trial should be initiated as early as 24 h after initial intubation |
- Citation: Gandhi KD, Sharma M, Taweesedt PT, Surani S. Role of proning and positive end-expiratory pressure in COVID-19. World J Crit Care Med 2021; 10(5): 183-193
- URL: https://www.wjgnet.com/2220-3141/full/v10/i5/183.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v10.i5.183