Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19 : a narrative review

Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved..

COVID-19 pneumonia is associated with hypoxaemic respiratory failure, ranging from mild to severe. Because of the worldwide shortage of ICU beds, a relatively high number of patients with respiratory failure are receiving prolonged noninvasive respiratory support, even when their clinical status would have required invasive mechanical ventilation. There are few experimental and clinical data reporting that vigorous breathing effort during spontaneous ventilation can worsen lung injury and cause a phenomenon that has been termed patient self-inflicted lung injury (P-SILI). The aim of this narrative review is to provide an overview of P-SILI pathophysiology and the role of noninvasive respiratory support in COVID-19 pneumonia. Respiratory mechanics, vascular compromise, viscoelastic properties, lung inhomogeneity, work of breathing, and oesophageal pressure swings are discussed. The concept of P-SILI has been widely investigated in recent years, but controversies persist regarding its mechanisms. To minimise the risk of P-SILI, intensivists should better understand its underlying pathophysiology to optimise the type of noninvasive respiratory support provided to patients with COVID-19 pneumonia, and decide on the optimal timing of intubation for these patients.

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:127

Enthalten in:

British journal of anaesthesia - 127(2021), 3 vom: 15. Sept., Seite 353-364

Sprache:

Englisch

Beteiligte Personen:

Battaglini, Denise [VerfasserIn]
Robba, Chiara [VerfasserIn]
Ball, Lorenzo [VerfasserIn]
Silva, Pedro L [VerfasserIn]
Cruz, Fernanda F [VerfasserIn]
Pelosi, Paolo [VerfasserIn]
Rocco, Patricia R M [VerfasserIn]

Links:

Volltext

Themen:

ARDS
COVID-19
High-flow nasal oxygen therapy
Journal Article
Lung injury
Noninvasive ventialtion
P-SILI
Research Support, Non-U.S. Gov't
Review
SARS-CoV-2
Spontaneous breathing

Anmerkungen:

Date Completed 26.08.2021

Date Revised 18.09.2023

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1016/j.bja.2021.05.024

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM327641320