Mechanical respiratory support for COVID-19: lessons from 2020

Intensive therapy of out-of-hospital pneumonia in conditions mass admission patients during 2020 presented many lessons, including regarding the strategy respiratory support, as it turned out that mechanical ventilation passive with COVID-19 is almost equivalent to a death sentence. On other hand, maintaining spontaneous breathing dyspnea and hyperpnea can cause specific self-inflicted lung injury Unexpectedly, good tolerability hypoxemia by has led emergence terms “happy hypoxia” “permissive hypoxemia,” reflecting effective functioning acute adaptation mechanisms: increasing heart productivity oxygen utilization. A step-by-step for was formed: 1) (low-flow, high-flow), 2) non-invasive support (NIV), 3) controlled ventilation. Among most resources mobilizing alveoli prone position. Compared tight mask, helmet be method conducting NIV. When using helmet, bedsores on face bridge nose do not develop, enteral nutrition possible, subjective NIV increased. Conversion invasive considered case energy inadmissibility development central nervous system disorders. Breathing equipment wide range modes expert capabilities monitoring needed carry both especially If pulmonary gas exchange only means saving patient remains extracorporeal membrane oxygenation — requires huge costs from trained medical personnel technical clinic. One visible lessons pandemic viral unsuccessful attempt speed up training “intensive care specialists” through on-line courses, webinars even guide sheets.