COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?
COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?
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DOI：
10.1016/s2213-2600(20)30304-0
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发表时间：
2020-08-01
影响因子：
76.2
通讯作者：
Brodie, Daniel
中科院分区：
文献类型：
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作者：
Fan, Eddy;Beitler, Jeremy R.;Brodie, Daniel
COVID-19大流行导致地球仪重症监护室的急性呼吸窘迫综合征（ARDS）患者激增。随着管理COVID-19相关ARDS患者的经验不断丰富，根据呼吸系统力学对患者进行分类的努力也不断增加，以期优化通气管理。个性化肺保护性机械通气可降低死亡率，已成为ARDS治疗的主要手段。在本观点中，我们在最近关于COVID-19相关ARDS患者表型异质性的讨论背景下讨论了缓解策略。尽管早期报告表明COVID-19相关的ARDS具有区别于历史ARDS的独特特征，但新出现的证据表明，无论是否患有COVID-19，ARDS患者的呼吸系统机制大致相似。在缺乏证据支持从目前的治疗模式转变的情况下，我们强烈建议在资源允许的情况下，坚持循证管理，并通过床旁生理学来了解。
The COVID-19 pandemic has seen a surge of patients with acute respiratory distress syndrome (ARDS) in intensive care units across the globe. As experience of managing patients with COVID-19-associated ARDS has grown, so too have efforts to classify patients according to respiratory system mechanics, with a view to optimising ventilatory management. Personalised lung-protective mechanical ventilation reduces mortality and has become the mainstay of treatment in ARDS. In this Viewpoint, we address ventilatory strategies in the context of recent discussions on phenotypic heterogeneity in patients with COVID-19-associated ARDS. Although early reports suggested that COVID-19-associated ARDS has distinctive features that set it apart from historical ARDS, emerging evidence indicates that the respiratory system mechanics of patients with ARDS, with or without COVID-19, are broadly similar. In the absence of evidence to support a shift away from the current paradigm of ventilatory management, we strongly recommend adherence to evidence-based management, informed by bedside physiology, as resources permit.