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Respiratory Support in ICU: The COVID-19 Lessons
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Respiratory Support in ICU: The COVID-19 Lessons

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 6277

Special Issue Editor

Dr. Paolo Formenti

E-Mail Website
Guest Editor
Departement of Anesthesia and Intensive Care, ASST Nord Milano, Ospedale E Bassini, 20092 Cinisello Balsamo, Italy
Interests: respiratory care; respiratory physiology; ultrasound; lung imaging; pain medicine; anesthesiology; sepsi and new biomarkers; nutritional support in ICU; humanization of intensive care
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue will focus on the management of respiratory diseases in critical care patients based on what we learned from SARS COV 2. From a clinical point of view, we did learn a lot of lessons about many clinical issues such as non-invasive respiratory support, invasive ventilation, prone positioning, aerosol-generating procedures, shared ventilation, issues related to oxygen therapy, silent hypoxemia, ventilator shortages, and long COVID.

This Special Issue aims to discuss new strategies of respiratory support, including the integrated metabolic and cardiovascular support.

We are looking for original articles and reviews dealing with novelty in respiratory strategies approaches changed during the last three years.

Dr. Paolo Formenti
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ICU management after COVID-19
  • respiratory care
  • ARDS
  • nutritional support
  • diagnostic and therapeutic strategies

Published Papers (4 papers)

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Research

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14 pages, 791 KiB  
Article
A High Respiratory Drive Is Associated with Weaning Failure in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome: The Role of the Electrical Activity of the Diaphragm
by Stefano Muttini, Jacopo Jona Falco, Ilmari Cuevas Cairo and Michele Umbrello
J. Clin. Med. 2024, 13(4), 1120; https://doi.org/10.3390/jcm13041120 - 16 Feb 2024
Viewed by 680
Abstract
Background: Mechanical ventilation is the main supportive treatment of severe cases of COVID-19-associated ARDS (C-ARDS). Weaning failure is common and associated with worse outcomes. We investigated the role of respiratory drive, assessed by monitoring the electrical activity of the diaphragm (EAdi), as a [...] Read more.
Background: Mechanical ventilation is the main supportive treatment of severe cases of COVID-19-associated ARDS (C-ARDS). Weaning failure is common and associated with worse outcomes. We investigated the role of respiratory drive, assessed by monitoring the electrical activity of the diaphragm (EAdi), as a predictor of weaning failure. Methods: Consecutive, mechanically ventilated patients admitted to the ICU for C-ARDS with difficult weaning were enrolled. Blood gas, ventilator, and respiratory mechanic parameters, as well as EAdi, were recorded at the time of placement of EAdi catheter, and then after 1, 2, 3, 7, and 10 days, and compared between patients with weaning success and weaning failure. Results: Twenty patients were enrolled: age 66 (60–69); 85% males; PaO2/FiO2 at admission 148 (126–177) mmHg. Thirteen subjects (65%) were classified as having a successful weaning. A younger age (OR(95%CI): 0.02 (0.01–0.11) per year), a higher PaO2/FiO2 ratio (OR(95%CI): 1.10 (1.01–1.21) per mmHg), and a lower EAdi (OR(95%CI): 0.16 (0.08–0.34) per μV) were associated with weaning success. Conclusion: In critically ill patients with moderate–severe C-ARDS and difficult weaning from mechanical ventilation, a successful weaning was associated with a lower age, a higher oxygenation, and a lower respiratory drive, as assessed at the bedside via EAdi monitoring. Full article
(This article belongs to the Special Issue Respiratory Support in ICU: The COVID-19 Lessons)
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14 pages, 2161 KiB  
Article
PEEP Titration Is Markedly Affected by Trunk Inclination in Mechanically Ventilated Patients with COVID-19 ARDS: A Physiologic, Cross-Over Study
by Francesco Marrazzo, Stefano Spina, Francesco Zadek, Clarissa Forlini, Gabriele Bassi, Riccardo Giudici, Giacomo Bellani, Roberto Fumagalli and Thomas Langer
J. Clin. Med. 2023, 12(12), 3914; https://doi.org/10.3390/jcm12123914 - 8 Jun 2023
Cited by 6 | Viewed by 2064
Abstract
Background: Changing trunk inclination affects lung function in patients with ARDS. However, its impacts on PEEP titration remain unknown. The primary aim of this study was to assess, in mechanically ventilated patients with COVID-19 ARDS, the effects of trunk inclination on PEEP titration. [...] Read more.
Background: Changing trunk inclination affects lung function in patients with ARDS. However, its impacts on PEEP titration remain unknown. The primary aim of this study was to assess, in mechanically ventilated patients with COVID-19 ARDS, the effects of trunk inclination on PEEP titration. The secondary aim was to compare respiratory mechanics and gas exchange in the semi-recumbent (40° head-of-the-bed) and supine-flat (0°) positions following PEEP titration. Methods: Twelve patients were positioned both at 40° and 0° trunk inclination (randomized order). The PEEP associated with the best compromise between overdistension and collapse guided by Electrical Impedance Tomography (PEEPEIT) was set. After 30 min of controlled mechanical ventilation, data regarding respiratory mechanics, gas exchange, and EIT parameters were collected. The same procedure was repeated for the other trunk inclination. Results: PEEPEIT was lower in the semi-recumbent than in the supine-flat position (8 ± 2 vs. 13 ± 2 cmH2O, p < 0.001). A semi-recumbent position with optimized PEEP resulted in higher PaO2:FiO2 (141 ± 46 vs. 196 ± 99, p = 0.02) and a lower global inhomogeneity index (46 ± 10 vs. 53 ± 11, p = 0.008). After 30 min of observation, a loss of aeration (measured by EIT) was observed only in the supine-flat position (−153 ± 162 vs. 27 ± 203 mL, p = 0.007). Conclusions: A semi-recumbent position is associated with lower PEEPEIT and results in better oxygenation, less derecruitment, and more homogenous ventilation compared to the supine-flat position. Full article
(This article belongs to the Special Issue Respiratory Support in ICU: The COVID-19 Lessons)
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Review

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18 pages, 2459 KiB  
Review
The Respiratory Mechanics of COVID-19 Acute Respiratory Distress Syndrome—Lessons Learned?
by Rebecca L. Kummer and John J. Marini
J. Clin. Med. 2024, 13(7), 1833; https://doi.org/10.3390/jcm13071833 - 22 Mar 2024
Cited by 1 | Viewed by 948
Abstract
Acute respiratory distress syndrome (ARDS) is a well-defined clinical entity characterized by the acute onset of diffuse pulmonary injury and hypoxemia not explained by fluid overload. The COVID-19 pandemic brought about an unprecedented volume of patients with ARDS and challenged our understanding and [...] Read more.
Acute respiratory distress syndrome (ARDS) is a well-defined clinical entity characterized by the acute onset of diffuse pulmonary injury and hypoxemia not explained by fluid overload. The COVID-19 pandemic brought about an unprecedented volume of patients with ARDS and challenged our understanding and clinical approach to treatment of this clinical syndrome. Unique to COVID-19 ARDS is the disruption and dysregulation of the pulmonary vascular compartment caused by the SARS-CoV-2 virus, which is a significant cause of hypoxemia in these patients. As a result, gas exchange does not necessarily correlate with respiratory system compliance and mechanics in COVID-19 ARDS as it does with other etiologies. The purpose of this review is to relate the mechanics of COVID-19 ARDS to its underlying pathophysiologic mechanisms and outline the lessons we have learned in the management of this clinic syndrome. Full article
(This article belongs to the Special Issue Respiratory Support in ICU: The COVID-19 Lessons)
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13 pages, 1343 KiB  
Review
Metabolic Support in Acute Respiratory Distress Syndrome: A Narrative Review
by Michele Umbrello, John J. Marini and Paolo Formenti
J. Clin. Med. 2023, 12(9), 3216; https://doi.org/10.3390/jcm12093216 - 29 Apr 2023
Viewed by 2172
Abstract
Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic [...] Read more.
Nutritional support for acute respiratory distress syndrome (ARDS) patients shares metabolic notions common to other critically ill conditions. Nevertheless, it generates specific concern regarding the primary limitation of oxygen supply and the complications of carbon dioxide elimination, as well as the significant metabolic alterations due to the body’s response to illness. In the present narrative review, after briefly summarizing the pathophysiology of critical illness stress response and patients’ metabolic requirements, we focus on describing the characteristics of metabolic and artificial nutrition in patients with acute respiratory failure. In patients with ARDS, several aspects of metabolism assume special importance. The physiological effects of substrate metabolism are described for this setting, particularly regarding energy consumption, diet-induced thermogenesis, and the price of their clearance, transformation, and storage. Moreover, we review the possible direct effects of macronutrients on lung tissue viability during ARDS. Finally, we summarize the noteworthy characteristics of metabolic control in critically ill patients with ARDS and offer a suggestion as to the ideal methods of metabolic support for this problem. Full article
(This article belongs to the Special Issue Respiratory Support in ICU: The COVID-19 Lessons)
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