Which medication helps to treat infection in a patient with acute respiratory failure

Vol 88, No 3 (2020)

Guidelines / Expert consensus

Submitted: 2020-06-05

Accepted: 2020-06-29

Published online: 2020-07-18

Treatment of acute respiratory failure in the course of COVID-19. Practical hints from the expert panel of the Assembly of Intensive Care and Rehabilitation of the Polish Respiratory Society

Malgorzata Czajkowska-Malinowska1, Aleksander Kania2, Paweł Jan Kuca3, Jacek Nasiłowski4, Szymon Skoczyński5, Rafał Sokołowski6, Paweł Stanislaw Śliwiński7

DOI: 10.5603/ARM.2020.0109

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Adv Respir Med 2020;88(3):245-266.

1. Department of Lung Diseases and Respiratory Failure, Centre of Sleep Medicine and Respiratory Care, Kujawy-Pomerania Pulmonology Centre, Bydgoszcz, Poland
2. Jagiellonian University Medical College, Faculty of Medicine, Second Department of Medicine, Department of Pulmonology, Kraków, Poland
3. Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
4. Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
5. Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
6. Department of Internal Medicine, Pneumonology, Allergology and Clinical Immunology, Military Medical Institute, Warsaw, Poland
7. 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland

Vol 88, No 3 (2020)

GUIDELINES

Submitted: 2020-06-05

Accepted: 2020-06-29

Published online: 2020-07-18

Abstract

In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a result of COVID-19 can develop very quickly and a small percent of those infected will die because of it. There is currently no treatment for COVID-19, therefore the key therapeutic intervention centers around the symptomatic treatment of respiratory failure. The main therapeutic goal is to main-tain gas exchange, mainly oxygenation, at an appropriate level and prevent the intensification of changes in the lung parenchyma. Depending on the severity of hypoxemia different techniques can be used to improve oxygenation. Medical staff dealing with COVID-19 patients should be familiar with both, methods used to treat respiratory failure and the epidemiological risks arising from their use. In some patients, conventional (passive) oxygen therapy alone is sufficient. In patients with worsening respiratory failure high flow nasal oxygen therapy (HFNOT) may be effective. The continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) methods can be used to a limited extent. With further disease progression, invasive ventilation must be used and in special situations, extracorporeal membrane oxygenation (ECMO) can also be administered.
The authors of this article set themselves the goal of presenting the most current knowledge about the epidemiology and patho-physiology of respiratory failure in COVID-19, as well as the methods of its treatment. Given the dynamics of the developing pandemic, this is not an easy task as new scientific data is presented almost every day. However, we believe the knowledge contained in this study will help doctors care for patients with COVID-19. The main target audience of this study is not so much pneumonologists or intensivists who have extensive experience in the application of the techniques discussed here, but rather doctors of other specializations who must master new skills in order to help patients during the time of a pandemic.

Abstract

In 2019, a pandemic began due to infection with a novel coronavirus, SARS-CoV-2. In many cases, this coronavirus leads to the development of the COVID-19 disease. Lung damage in the course of this disease often leads to acute hypoxic respiratory failure and may eventually lead to acute respiratory distress syndrome (ARDS). Respiratory failure as a result of COVID-19 can develop very quickly and a small percent of those infected will die because of it. There is currently no treatment for COVID-19, therefore the key therapeutic intervention centers around the symptomatic treatment of respiratory failure. The main therapeutic goal is to main-tain gas exchange, mainly oxygenation, at an appropriate level and prevent the intensification of changes in the lung parenchyma. Depending on the severity of hypoxemia different techniques can be used to improve oxygenation. Medical staff dealing with COVID-19 patients should be familiar with both, methods used to treat respiratory failure and the epidemiological risks arising from their use. In some patients, conventional (passive) oxygen therapy alone is sufficient. In patients with worsening respiratory failure high flow nasal oxygen therapy (HFNOT) may be effective. The continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV) methods can be used to a limited extent. With further disease progression, invasive ventilation must be used and in special situations, extracorporeal membrane oxygenation (ECMO) can also be administered.
The authors of this article set themselves the goal of presenting the most current knowledge about the epidemiology and patho-physiology of respiratory failure in COVID-19, as well as the methods of its treatment. Given the dynamics of the developing pandemic, this is not an easy task as new scientific data is presented almost every day. However, we believe the knowledge contained in this study will help doctors care for patients with COVID-19. The main target audience of this study is not so much pneumonologists or intensivists who have extensive experience in the application of the techniques discussed here, but rather doctors of other specializations who must master new skills in order to help patients during the time of a pandemic.

Keywords

acute respiratory failure; ventilatory support; CPAP; non-invasive mechanical ventilation; high flow nasal oxygen therapy; SARS; coronavirus; pandemic; COVID-19

Title

Treatment of acute respiratory failure in the course of COVID-19. Practical hints from the expert panel of the Assembly of Intensive Care and Rehabilitation of the Polish Respiratory Society

Advances in Respiratory Medicine

Vol 88, No 3 (2020)

Guidelines / Expert consensus

245-266

2020-07-18

3665

3427

10.5603/ARM.2020.0109

32706108

Adv Respir Med 2020;88(3):245-266.

Keywords

acute respiratory failure
ventilatory support
CPAP
non-invasive mechanical ventilation
high flow nasal oxygen therapy
SARS
coronavirus
pandemic
COVID-19

Authors

Malgorzata Czajkowska-Malinowska
Aleksander Kania
Paweł Jan Kuca
Jacek Nasiłowski
Szymon Skoczyński
Rafał Sokołowski
Paweł Stanislaw Śliwiński

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