Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19
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Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19. / Pfeifer, Michael; Ewig, Santiago; Voshaar, Thomas; Randerath, Winfried Johannes; Bauer, Torsten; Geiseler, Jens; Dellweg, Dominic; Westhoff, Michael; Windisch, Wolfram; Schönhofer, Bernd; Kluge, Stefan; Lepper, Philipp M.
In: RESPIRATION, Vol. 99, No. 6, 2020, p. 521-542.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19
AU - Pfeifer, Michael
AU - Ewig, Santiago
AU - Voshaar, Thomas
AU - Randerath, Winfried Johannes
AU - Bauer, Torsten
AU - Geiseler, Jens
AU - Dellweg, Dominic
AU - Westhoff, Michael
AU - Windisch, Wolfram
AU - Schönhofer, Bernd
AU - Kluge, Stefan
AU - Lepper, Philipp M
PY - 2020
Y1 - 2020
N2 - Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for COVID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COVID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early- and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or capillary blood gas analysis under room air conditions, and it needs to include the calculation of oxygen supply (measured from the variables of oxygen saturation, hemoglobin level, the corrected values of Hüfner's factor, and cardiac output). Aerosols can cause transmission of infectious, virus-laden particles. Open systems or vented systems can increase the release of respirable particles. Procedures in which the invasive ventilation system must be opened and endotracheal intubation carried out are associated with an increased risk of infection. Personal protective equipment (PPE) should have top priority because fear of contagion should not be a primary reason for intubation. Based on the current knowledge, inhalation therapy, nasal high-flow therapy (NHF), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) can be performed without an increased risk of infection to staff if PPE is provided. A significant proportion of patients with ARF present with relevant hypoxemia, which often cannot be fully corrected, even with a high inspired oxygen fraction (FiO2) under NHF. In this situation, the oxygen therapy can be escalated to CPAP or NIV when the criteria for endotracheal intubation are not met. In ARF, NIV should be carried out in an intensive care unit or a comparable setting by experienced staff. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring and readiness for intubation are to be ensured at all times. If the ARF progresses under CPAP/NIV, intubation should be implemented without delay in patients who do not have a "do not intubate" order.
AB - Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for COVID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COVID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early- and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or capillary blood gas analysis under room air conditions, and it needs to include the calculation of oxygen supply (measured from the variables of oxygen saturation, hemoglobin level, the corrected values of Hüfner's factor, and cardiac output). Aerosols can cause transmission of infectious, virus-laden particles. Open systems or vented systems can increase the release of respirable particles. Procedures in which the invasive ventilation system must be opened and endotracheal intubation carried out are associated with an increased risk of infection. Personal protective equipment (PPE) should have top priority because fear of contagion should not be a primary reason for intubation. Based on the current knowledge, inhalation therapy, nasal high-flow therapy (NHF), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) can be performed without an increased risk of infection to staff if PPE is provided. A significant proportion of patients with ARF present with relevant hypoxemia, which often cannot be fully corrected, even with a high inspired oxygen fraction (FiO2) under NHF. In this situation, the oxygen therapy can be escalated to CPAP or NIV when the criteria for endotracheal intubation are not met. In ARF, NIV should be carried out in an intensive care unit or a comparable setting by experienced staff. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring and readiness for intubation are to be ensured at all times. If the ARF progresses under CPAP/NIV, intubation should be implemented without delay in patients who do not have a "do not intubate" order.
KW - Acute Disease
KW - Betacoronavirus
KW - Coronavirus Infections/complications
KW - Disease Progression
KW - Germany
KW - Humans
KW - Hypoxia/etiology
KW - Pandemics
KW - Patient Acuity
KW - Pneumonia, Viral/complications
KW - Respiration Disorders/etiology
KW - Respiration, Artificial
KW - Respiratory Distress Syndrome, Adult/etiology
KW - Respiratory Insufficiency/etiology
U2 - 10.1159/000509104
DO - 10.1159/000509104
M3 - SCORING: Journal article
C2 - 32564028
VL - 99
SP - 521
EP - 542
JO - RESPIRATION
JF - RESPIRATION
SN - 0025-7931
IS - 6
ER -