Download PDF
Semin Respir Crit Care Med 2023; 44(01): 091-099
DOI: 10.1055/s-0042-1758836
Review Article

Techniques for Oxygenation and Ventilation in Coronavirus Disease 2019

Guy A. Richards
1   Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa
,
Oliver Smith
2   Department of Critical Care and Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

This paper discusses mechanisms of hypoxemia and interventions to oxygenate critically ill patients with COVID-19 which range from nasal cannula to noninvasive and mechanical ventilation. Noninvasive ventilation includes continuous positive airway pressure ventilation (CPAP) and high-flow nasal cannula (HFNC) with or without proning. The evidence for each of these modalities is discussed and thereafter, when to transition to mechanical ventilation (MV). Various techniques of MV, again with and without proning, and rescue strategies which would include extra corporeal membrane oxygenation (ECMO) when it is available and permissive hypoxemia where it is not, are discussed.

Keywords

COVID-19 - high-flow nasal oxygen - continuous positive airway pressure - mechanical ventilation - rescue strategies


Publication History

Article published online:
16 January 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Bhimraj A, Morgan RL, Shumaker AH. et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19–19. Accessed March 28, 2022 at: https://www.idsociety.org/globalassets/idsa/practice-guidelines/COVID-19-19/treatment/idsa-COVID-19-19-gl-tx-and-mgmt-v8.0.0.pdf
    PubMedGoogle Scholar
  • 2 Ma X, Vervoort D. Critical care capacity during the COVID-19 pandemic: global availability of intensive care beds. J Crit Care 2020; 58: 96-97
    CrossrefPubMedGoogle Scholar
  • 3 Aziz S, Arabi YM, Alhazzani W. et al. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020; 46 (07) 1303-1325
    CrossrefPubMedGoogle Scholar
  • 4 Halpern NA, Tan KS. United States resource availability for COVID-19–19. Accessed June 14, 2022 at: https://sccm.org/getattachment/Blog/March-2020/United-States-Resource-Availability-for-COVID-19–19/United-States-Resource-Availability-for-COVID-19–19.pdf?lang=en-US
    PubMedGoogle Scholar
  • 5 Joynt GM, Gopalan DP, Argent AA. et al. The Critical Care Society of Southern Africa Consensus Guideline on ICU triage and rationing (ConICTri). S Afr Med J 2019; 109 (8b): 630-642
    CrossrefPubMedGoogle Scholar
  • 6 Jimenez JV, Olivas-Martinez A, Rios-Olais FA. et al. Outcomes in temporary ICUs versus conventional ICUs: an observational cohort of mechanically ventilated patients with COVID-19-induced acute respiratory distress syndrome. Crit Care Explor 2022; 4 (04) e0668
    CrossrefPubMedGoogle Scholar
  • 7 Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020; 135 (23) 2033-2040
    CrossrefPubMedGoogle Scholar
  • 8 Gattinoni L, Gattarello S, Steinberg I. et al. COVID-19 pneumonia: pathophysiology and management. Eur Respir Rev 2021; 30 (162) 210138
    CrossrefPubMedGoogle Scholar
  • 9 Gattinoni L, Chiumello D, Caironi P. et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med 2020; 46 (06) 1099-1102
    CrossrefPubMedGoogle Scholar
  • 10 Reynolds AS, Lee AG, Renz J. et al. Pulmonary vascular dilatation detected by automated transcranial Doppler in COVID-19–19 pneumonia. Am J Respir Crit Care Med 2020; 202 (07) 1037-1039
    CrossrefPubMedGoogle Scholar
  • 11 Tobin MJ, Laghi F, Jubran A. Caution about early intubation and mechanical ventilation in COVID-19. Ann Intensive Care 2020; 10 (01) 78
    CrossrefPubMedGoogle Scholar
  • 12 Barisione E, Grillo F, Ball L. et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows Arch 2021; 478 (03) 471-485
    CrossrefPubMedGoogle Scholar
  • 13 Vandenbunder B, Ehrmann S, Piagnerelli M. et al; COVADIS study group. Static compliance of the respiratory system in COVID-19 related ARDS: an international multicenter study. Crit Care 2021; 25 (01) 52
    CrossrefPubMedGoogle Scholar
  • 14 Grieco DL, Bongiovanni F, Chen L. et al. Respiratory physiology of COVID-19-induced respiratory failure compared to ARDS of other etiologies. Crit Care 2020; 24 (01) 529
    CrossrefPubMedGoogle Scholar
  • 15 Trahtemberg U, Slutsky AS, Villar J. What have we learned ventilating COVID-19 patients?. Intensive Care Med 2020; 46 (12) 2458-2460
    CrossrefPubMedGoogle Scholar
  • 16 Fan E, Beitler JR, Brochard L. et al. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?. Lancet Respir Med 2020; 8 (08) 816-821
    CrossrefPubMedGoogle Scholar
  • 17 Ware LB. Physiological and biological heterogeneity in COVID-19-associated acute respiratory distress syndrome. Lancet Respir Med 2020; 8 (12) 1163-1165
    CrossrefPubMedGoogle Scholar
  • 18 Heuer AJ, Hilse AM. 2021. Chapter 42: Medical gas therapy. In: Kacmarek RM, Stoller JK, Heuer AJ. eds., Egan's Fundamentals of Respiratory Care. 12th ed.. St. Louis: Elsevier; 906-934
    Google Scholar
  • 19 Mauri T, Galazzi A, Binda F. et al. Impact of flow and temperature on patient comfort during respiratory support by high-flow nasal cannula. Crit Care 2018; 22 (01) 120
    Google Scholar
  • 20 Miller T, Saberi B, Saberi S. Computational fluid dynamics modeling of extrathoracic airway flush: evaluation of high flow nasal cannula design elements. J Pulm Respir Med 2016; 6 (05) 376
    CrossrefPubMedGoogle Scholar
  • 21 Nishimura M. High-flow nasal cannula oxygen therapy devices. Respir Care 2019; 64 (06) 735-742
    CrossrefPubMedGoogle Scholar
  • 22 Parke RL, McGuinness SP. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care 2013; 58 (10) 1621-1624
    CrossrefPubMedGoogle Scholar
  • 23 Montiel V, Robert A, Robert A. et al. Surgical mask on top of high-flow nasal cannula improves oxygenation in critically ill COVID-19 patients with hypoxemic respiratory failure. Ann Intensive Care 2020; 10 (01) 125
    CrossrefPubMedGoogle Scholar
  • 24 Dogani B, Månsson F, Resman F, Hartman H, Tham J, Torisson G. The application of an oxygen mask, without supplemental oxygen, improved oxygenation in patients with severe COVID-19 already treated with high-flow nasal cannula. Crit Care 2021; 25 (01) 319
    CrossrefPubMedGoogle Scholar
  • 25 Calligaro GL, Lalla U, Audley G. et al. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study. EClinicalMedicine 2020; 28: 100570
    CrossrefPubMedGoogle Scholar
  • 26 Demoule A, Vieillard Baron A, Darmon M. et al. High-flow nasal cannula in critically III patients with severe COVID-19. Am J Respir Crit Care Med 2020; 202 (07) 1039-1042
    CrossrefPubMedGoogle Scholar
  • 27 Ehrmann S, Li J, Ibarra-Estrada M. et al; Awake Prone Positioning Meta-Trial Group. Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure: a randomised, controlled, multinational, open-label meta-trial. Lancet Respir Med 2021; 9 (12) 1387-1395
    CrossrefPubMedGoogle Scholar
  • 28 Fralick M, Colacci M, Munshi L. et al; COVID Prone Study Investigators. Prone positioning of patients with moderate hypoxaemia due to covid-19: multicentre pragmatic randomised trial (COVID-PRONE). BMJ 2022; 376: e068585
    CrossrefPubMedGoogle Scholar
  • 29 Barker J, Koeckerling D, Mudalige NL, Oyefeso O, Pan D. Awake prone positioning for patients with covid-19. BMJ 2022; 376: o632
    CrossrefPubMedGoogle Scholar
  • 30 Musso G, Taliano C, Molinaro F. et al. Early prolonged prone position in noninvasively ventilated patients with SARS-CoV-2-related moderate-to-severe hypoxemic respiratory failure: clinical outcomes and mechanisms for treatment response in the PRO-NIV study. Crit Care 2022; 26 (01) 118
    CrossrefPubMedGoogle Scholar
  • 31 Ibarra-Estrada M, Li J, Pavlov I. et al. Factors for success of awake prone positioning in patients with COVID-19-induced acute hypoxemic respiratory failure: analysis of a randomized controlled trial. Crit Care 2022; 26 (01) 84
    CrossrefPubMedGoogle Scholar
  • 32 Scala R, Pisani L. Noninvasive ventilation in acute respiratory failure: which recipe for success?. Eur Respir Rev 2018; 27 (149) 180029
    CrossrefPubMedGoogle Scholar
  • 33 Soo Hoo GW. Noninvasive Ventilation. Jun 18, 2020. Updated. Medscape. Accessed April 6, 2022 at: https://emedicine.medscape.com/article/304235-print
    PubMedGoogle Scholar
  • 34 Cammarota G, Esposito T, Azzolina D. et al. Noninvasive respiratory support outside the intensive care unit for acute respiratory failure related to coronavirus-19 disease: a systematic review and meta-analysis. Crit Care 2021; 25 (01) 268
    CrossrefPubMedGoogle Scholar
  • 35 Bradley P, Wilson J, Taylor R. et al. Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation. EClinicalMedicine 2021; 40: 101122
    CrossrefPubMedGoogle Scholar
  • 36 Avdeev SN, Yaroshetskiy AI, Tsareva NA. et al. Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19. Am J Emerg Med 2021; 39: 154-157
    CrossrefPubMedGoogle Scholar
  • 37 Ferreyro BL, Angriman F, Munshi L. et al. Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis. JAMA 2020; 324 (01) 57-67
    Google Scholar
  • 38 Chaudhuri D, Jinah R, Burns KEA. et al. Helmet noninvasive ventilation compared to facemask noninvasive ventilation and high-flow nasal cannula in acute respiratory failure: a systematic review and meta-analysis. Eur Respir J 2022; 59 (03) 2101269
    Google Scholar
  • 39 Perkins GD, Ji C, Connolly BA. et al; Effect of noninvasive respiratory strategies on intubation or mortality among patients with acute hypoxemic respiratory failure and COVID-19: the RECOVERY-RS randomized clinical trial. JAMA 2022; 327 (06) 546-558
    Google Scholar
  • 40 Lim ZJ, Subramaniam A, Ponnapa Reddy M. et al. Case fatality rates for patients with COVID-19 requiring invasive mechanical ventilation. A meta-analysis. Am J Respir Crit Care Med 2021; 203 (01) 54-66
    CrossrefPubMedGoogle Scholar
  • 41 Blez D, Soulier A, Bonnet F, Gayat E, Garnier M. Monitoring of high-flow nasal cannula for SARS-CoV-2 severe pneumonia: less is more, better look at respiratory rate. Intensive Care Med 2020; 46 (11) 2094-2095
    CrossrefPubMedGoogle Scholar
  • 42 Roca O, Caralt B, Messika J. et al. An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy. Am J Respir Crit Care Med 2019; 199 (11) 1368-1376
    CrossrefPubMedGoogle Scholar
  • 43 Simioli F, Annunziata A, Langella G, Polistina GE, Martino M, Fiorentino G. Clinical outcomes of high-flow nasal cannula in COVID-19 associated postextubation respiratory failure. A single-centre case series. Anaesthesiol Intensive Ther 2020; 52 (05) 373-376
    CrossrefPubMedGoogle Scholar
  • 44 Winck JC, Scala R. Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm. Pulmonology 2021; 27 (04) 305-312
    CrossrefPubMedGoogle Scholar
  • 45 Voshaar T, Stais P, Köhler D, Dellweg D. Conservative management of COVID-19 associated hypoxaemia. ERJ Open Res 2021; 7 (02) 00134-2021
    CrossrefPubMedGoogle Scholar
  • 46 Vega ML, Dongilli R, Olaizola G. et al. COVID-19 pneumonia and ROX index: time to set a new threshold for patients admitted outside the ICU. Pulmonology 2022; 28 (01) 13-17
    CrossrefPubMedGoogle Scholar
  • 47 Yeates EO, Nahmias J, Chinn J. et al. Improved outcomes over time for adult COVID-19 patients with acute respiratory distress syndrome or acute respiratory failure. PLoS One 2021; 16 (06) e0253767
    CrossrefPubMedGoogle Scholar
  • 48 Serrano R, Corbella X, Rello J. Management of hypoxemia in SARS-CoV-2 infection: Lessons learned from one year of experience, with a special focus on silent hypoxemia. J Intensive Med 2021; 1 (01) 26-30
    CrossrefPubMedGoogle Scholar
  • 49 Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020; 75 (06) 785-799
    Google Scholar
  • 50 Shrestha GS, Shrestha N, Lamsal R. et al. Emergency intubation in COVID-19. N Engl J Med 2021; 384 (07) e20
    CrossrefPubMedGoogle Scholar
  • 51 Yao W, Wang T, Jiang B. et al; collaborators. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J Anaesth 2020; 125 (01) e28-e37
    CrossrefPubMedGoogle Scholar
  • 52 Papali A, Ingram AO, Rosenberger AM. et al. Intubation checklist for COVID-19 patients: a practical tool for bedside practitioners. Respir Care 2021; 66 (01) 138-143
    CrossrefPubMedGoogle Scholar
  • 53 Bellani G, Laffey JG, Pham T. et al; LUNG SAFE Investigators, ESICM Trials Group. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315 (08) 788-800
    Google Scholar
  • 54 Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020; 323 (22) 2329-2330
    CrossrefPubMedGoogle Scholar
  • 55 Grasselli G, Cattaneo E, Florio G. et al. Mechanical ventilation parameters in critically ill COVID-19 patients: a scoping review. Crit Care 2021; 25 (01) 115
    CrossrefPubMedGoogle Scholar
  • 56 Boers NS, Botta M, Tsonas AM. et al; PRoVENT-COVID investigators†. PRactice of VENTilation in Patients with Novel Coronavirus Disease (PRoVENT-COVID): rationale and protocol for a national multicenter observational study in The Netherlands. Ann Transl Med 2020; 8 (19) 1251
    CrossrefPubMedGoogle Scholar
  • 57 Nijbroek SGLH, Hol L, Ivanov D, Schultz MJ, Paulus F, Neto AS. PRoVENT-COVID Collaborative Group. Low tidal volume ventilation is associated with mortality in COVID-19 patients-insights from the PRoVENT-COVID study. J Crit Care 2022; 70: 154047
    CrossrefPubMedGoogle Scholar
  • 58 Ferreira JC, Ho YL, Besen BAMP. et al; EPICCoV Study Group. Protective ventilation and outcomes of critically ill patients with COVID-19: a cohort study. Ann Intensive Care 2021; 11 (01) 92
    PubMedGoogle Scholar
  • 59 Horby P, Lim WS, Emberson JR. et al; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021; 384 (08) 693-704
    CrossrefPubMedGoogle Scholar
  • 60 COVID-19–19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19–19) Treatment Guidelines. National Institutes of Health. Accessed June 12, 2022 at: https://www.COVID-1919treatmentguidelines.nih.gov/
    PubMedGoogle Scholar
  • 61 Gattinoni L, Marini JJ. In search of the Holy Grail: identifying the best PEEP in ventilated patients. Intensive Care Med 2022; 48: 728-731
    CrossrefPubMedGoogle Scholar
  • 62 Vignon P, Evrard B, Asfar P. et al. Fluid administration and monitoring in ARDS: which management?. Intensive Care Med 2020; 46 (12) 2252-2264
    CrossrefPubMedGoogle Scholar
  • 63 Del Sorbo L, Tonetti T, Ranieri VM. Alveolar recruitment in acute respiratory distress syndrome: should we open the lung (no matter what) or may accept (part of) the lung closed?. Intensive Care Med 2019; 45 (10) 1436-1439
    CrossrefPubMedGoogle Scholar
  • 64 Papazian L, Forel J-M, Gacouin A. et al; ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 2010; 363 (12) 1107-1116
    CrossrefPubMedGoogle Scholar
  • 65 Moss M, Huang DT, Brower RG. et al; National Heart, Lung, and Blood Institute PETAL Clinical Trials Network. Early neuromuscular blockade in the acute respiratory distress syndrome. N Engl J Med 2019; 380 (21) 1997-2008
    CrossrefPubMedGoogle Scholar
  • 66 He HW, Liu DW, Long Y, Wang XTJ. High central venous-to-arterial CO2 difference/arterial-central venous O2 difference ratio is associated with poor lactate clearance in septic patients after resuscitation. J Crit Care 2016; 31 (01) 76-81
    CrossrefPubMedGoogle Scholar
  • 67 Zhou Y, Jin X, Lv Y. et al. Early application of airway pressure release ventilation may reduce the duration of mechanical ventilation in acute respiratory distress syndrome. Intensive Care Med 2017; 43 (11) 1648-1659
    CrossrefPubMedGoogle Scholar
  • 68 Smith O, Richards GA. Acute respiratory distress syndrome. Since 1967 and still going strong. S Afr J Anaes Analg 2021; 27 (6, suppl 1): S98-S104
    PubMedGoogle Scholar
  • 69 Aslam TN, Klitgaard TL, Hofsø K, Rasmussen BS, Laake JH. Spontaneous versus controlled mechanical ventilation in patients with acute respiratory distress syndrome. Curr Anesthesiol Rep 2021; 11 (02) 85-91
    CrossrefPubMedGoogle Scholar
  • 70 Lim J, Litton E. Airway pressure release ventilation in adult patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Crit Care Med 2019; 47 (12) 1794-1799
    CrossrefPubMedGoogle Scholar
  • 71 Ibarra-Estrada MÁ, García-Salas Y, Mireles-Cabodevila E. et al. Use of airway pressure release ventilation in patients with acute respiratory failure due to COVID-19: results of a single-center randomized controlled trial. Crit Care Med 2022; 50 (04) 586-594
    CrossrefPubMedGoogle Scholar
  • 72 Zorbas JS, Ho KM, Litton E, Wibrow B, Fysh E, Anstey MH. Airway pressure release ventilation in mechanically ventilated patients with COVID-19: a multicenter observational study. Acute Crit Care 2021; 36 (02) 143-150
    CrossrefPubMedGoogle Scholar
  • 73 Whebell S, Zhang J, Lewis R. et al. Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study. Intensive Care Med 2022; 48 (04) 467-478
    CrossrefPubMedGoogle Scholar
  • 74 Roach A, Chikwe J, Catarino P. et al. Lung transplantation for Covid-19-related respiratory failure in the United States. N Engl J Med 2022; 386 (12) 1187-1188
    CrossrefPubMedGoogle Scholar