اولین همایش بین المللی تحول خدمات سلامت: تلفیق مراقبت، درمان، بازتوانی و امیدبخشی

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کد مقاله 1449

عنوان Mechanical Ventilation in Severe COVID-19: Clinical Determinants, Ventilator-Related Complications, and Critical Care Challenges

نویسندگان Hiva Nargesi Khoramabadi - Faezeh Kafi

چکیده Background: Mechanical ventilation is a central supportive intervention for patients with severe respiratory failure, including COVID-19-associated acute respiratory distress syndrome (ARDS) [1, 2]. The need for mechanical ventilation depends not only on the severity of pulmonary disease but also on patient characteristics, respiratory physiology, comorbidities, complications during ventilation, and the capacity of the health-care system to provide safe and timely critical care [3]. Method: This narrative review synthesizes the principal factors associated with the need for and management of mechanical ventilation in COVID-19, based on the original literature and subsequent evidence and contemporary ARDS guidance. Particular attention was given to pneumonia and ventilator-associated pneumonia, ARDS, hypoxemia, comorbidities, unplanned extubation, prolonged mechanical ventilation, ventilator-induced lung injury, fluid balance, prone positioning, and ventilator availability. Finding: The evidence indicates that safe mechanical ventilation in COVID-19 requires individualized lung-protective strategies, including low tidal volumes, appropriate positive end-expiratory pressure (PEEP), limitation of injurious airway pressures, and prone positioning in patients with severe ARDS. Although early reports proposed distinct COVID-19 respiratory phenotypes, subsequent larger analyses did not support abandoning conventional lung-protective ventilation [4]. Prevention and management of complications, including VAP, unplanned extubation, ventilator-induced lung injury, and complications associated with prolonged mechanical ventilation, are also essential. Careful fluid management and regular assessment for weaning and liberation from mechanical ventilation should be integrated into patient management [5]. During periods of limited ventilator availability, approaches such as split-ventilator systems and rapidly deployable ventilator designs may provide potential alternatives; however, their technical and clinical limitations must be considered. Conclusion: Mechanical ventilation in COVID-19-associated respiratory failure should be considered a dynamic and individualized process encompassing appropriate initiation, lung-protective ventilator settings, continuous monitoring, prevention of complications, prone positioning when indicated, and timely liberation from ventilation. Contemporary evidence supports applying established ARDS principles while adapting ventilation strategies to individual patient physiology and available health-care resources.

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