Current opinion in critical care
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Curr Opin Crit Care · Feb 2022
ReviewChest imaging in patients with acute respiratory failure because of coronavirus disease 2019.
This review aims to explore the different imaging modalities, such as chest radiography (CXR), computed tomography (CT), ultrasound, PET/CT scan, and MRI to describe the main features for the evaluation of the chest in COVID-19 patients with ARDS. ⋯ CT is the technique with higher sensitivity and definition for studying chest in COVID-19 patients. LUS or bedside CXR are critical in patients requiring close and repeated monitoring. Moreover, LUS and CXR reduce the radiation burden and the risk of infection compared with CT. PET/CT and MRI, especially in ARDS patients, are not usually used for diagnostic or follow-up purposes.
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Curr Opin Crit Care · Feb 2022
ReviewProtective ventilation in patients with acute respiratory distress syndrome related to COVID-19: always, sometimes or never?
To review current evidence on the pathophysiology of COVID-19-related acute respiratory distress syndrome (ARDS) and on the implementation of lung protective ventilation. ⋯ According to the present evidence, a lung protective strategy based on low tidal volume and plateau pressures is indicated in COVID-19-ARDS as in ARDS from other causes; however, there are still uncertainties on the appropriate levels of PEEP.
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Curr Opin Crit Care · Feb 2022
Ventilator-associated pneumonia among SARS-CoV-2 acute respiratory distress syndrome patients.
We conducted a systematic literature review to summarize the available evidence regarding the incidence, risk factors, and clinical characteristics of ventilator-associated pneumonia (VAP) in patients undergoing mechanical ventilation because of acute respiratory distress syndrome secondary to SARS-CoV-2 infection (C-ARDS). ⋯ Covid-19 patients who require mechanical ventilation for ARDS have a high risk (>50%) of developing VAP, most commonly because of Gram-negative bacteria. Further work is needed to elucidate the disease-specific risk factors for VAP, strategies for prevention, and how best to differentiate between bacterial colonization versus superinfection.
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Curr Opin Crit Care · Feb 2022
ReviewProne position in COVID 19-associated acute respiratory failure.
Prone position has been widely used in the COVID-19 pandemic, with an extension of its use in patients with spontaneous breathing ('awake prone'). We herein propose a review of the current literature on prone position in mechanical ventilation and while spontaneous breathing in patients with COVID-19 pneumonia or COVID-19 ARDS. ⋯ The final results of the several randomized control trials completed or ongoing are needed to confirm the trend of these results. In intubated patients, observational studies showed that responders to prone in terms of oxygenation had a better survival than nonresponders.
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Curr Opin Crit Care · Feb 2022
ReviewAdvanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome.
To summarize the current knowledge about the application of advanced monitoring techniques in coronavirus disease 2019 (COVID-19). ⋯ Although there is little data on the effectiveness of advanced monitoring techniques in COVID-19, regular monitoring should be a central part of the management of COVID-19-related acute respiratory distress syndrome (C-ARDS).