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...

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Vydané v:	The American journal of tropical medicine and hygiene Ročník 102; číslo 6; s. 1191
Hlavní autori:	Dondorp, Arjen M, Hayat, Muhammad, Aryal, Diptesh, Beane, Abi, Schultz, Marcus J
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 01.06.2020
Predmet:	Adenosine Monophosphate - analogs & derivatives Adenosine Monophosphate - therapeutic use Alanine - analogs & derivatives Alanine - therapeutic use Betacoronavirus - drug effects Betacoronavirus - pathogenicity Chloroquine - therapeutic use Continuous Positive Airway Pressure - economics Continuous Positive Airway Pressure - methods Coronavirus Infections - diagnostic imaging Coronavirus Infections - economics Coronavirus Infections - epidemiology Coronavirus Infections - therapy COVID-19 Developing Countries - economics Disease Management Humans Hydroxychloroquine - therapeutic use Lopinavir - therapeutic use Lung - diagnostic imaging Lung - pathology Lung - virology Oxygen - therapeutic use Pandemics - economics Pneumonia, Viral - diagnostic imaging Pneumonia, Viral - economics Pneumonia, Viral - epidemiology Pneumonia, Viral - therapy Respiration, Artificial - economics Respiration, Artificial - methods Ritonavir - therapeutic use SARS-CoV-2 Tomography, X-Ray Computed
ISSN:	1476-1645, 1476-1645
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Shrnutí:	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.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-Review-3 content type line 23
ISSN:	1476-1645 1476-1645
DOI:	10.4269/ajtmh.20-0283