Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports
Mian Peng, Di Ren, Yong-Feng Liu, Xi Meng, Ming Wu, Rong-Lin Chen, Bao-Jun Yu, Long-Cheng Tao, Li Chen, Zeng-Qiao Lai
Mian Peng, Long-Cheng Tao, Li Chen, Zeng-Qiao Lai, Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, Guangdong Province, China
Di Ren, Ming Wu, Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, Shenzhen 518035, Guangdong Province, China
Yong-Feng Liu, Rong-Lin Chen, Department of Intensive Care Unit, Shenzhen Longgang Central Hospital, Shenzhen 518116, Guangdong Province, China
Xi Meng, Department of Intensive Care Unit, The Third People’s Hospital of Shenzhen, Shenzhen 518112, Guangdong Province, China
Bao-Jun Yu, Department of Intensive Care Unit, Shenzhen Baoan District People’s Hospital, Shenzhen 518101, Guangdong Province, China
Author contributions: Peng M, Ren D, Liu YF and Meng X were the patient’s intensive care doctors, reviewed the literature and contributed to manuscript drafting; Wu M reviewed the literature and contributed to manuscript drafting; Chen RL and Yu BJ analyzed and interpreted the results and contributed to manuscript drafting; Tao LC, Chen L and Lai ZQ were responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Di Ren, MA, Attending Doctor, Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, No. 3002 Sungang West Road, Futian District, Shenzhen 518035, Guangdong Province, China.
ch2679@163.com
Received: April 22, 2020
Peer-review started: April 22, 2020
First decision: May 1, 2020
Revised: May 15, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 6, 2020
Processing time: 106 Days and 5 Hours
BACKGROUND
Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases.
CASE SUMMARY
Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients’ respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH2O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO2] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well.
CONCLUSION
A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.
Core tip: An effective and practical weaning protocol is of the utmost importance to coronavirus disease 2019 (COVID-19) patients with respiratory failure requiring mechanical ventilation. Here, we present two patients with critical COVID-19. Such patients can achieve good outcomes following a sequential weaning protocol that is attentive to the timing of intubation and extubation, early prone positioning, infection control, and sequential advancement and withdrawal of invasive ventilation.
