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COVID-19 Respiratory Support: Current Concept and Emerging Trends

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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 (20 December 2022) | Viewed by 19825

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Special Issue Editor

Prof. Dr. Guillaume Carteaux

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1. Service de Médecine Intensive Réanimation, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, F-94010 Creteil, France
2. Groupe de Recherche Clinique CARMAS, Faculté de Santé, Université Paris Est-Créteil, F-94010 Creteil, France
3. INSERM U955, Institut Mondor de Recherche Biomédicale, F-94010 Creteil, France
Interests: respiratory failure pathophysiology; mechanical ventilation; invasive and noninvasive respiratory support; acute respiratory distress syndrome; ventilation induced lung injury; patient–ventilator interactions; innovative solutions in ventilation and training

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic has exposed healthcare systems worldwide to a massive influx of patients with respiratory failure requiring respiratory support. Thus, many challenges arose at the same time: characterization of this new disease, delivery of adequate respiratory support, while facing major constraints such as risk of contamination and shortages of ICU beds, respiratory support devices, oxygen, and caregivers able to deliver ventilatory assistance. Meeting these unprecedented challenges required intense research including methodological, therapeutic, organizational, and educational innovations. After two years of the pandemic, this prolific research has significantly improved our knowledge of the pathophysiology of respiratory failure during COVID-19, generated hypotheses regarding the personalization of non-invasive and invasive respiratory support, and provided innovative solution to address a massive influx of patients. It is therefore important to review current concepts and emerging trends regarding ventilatory support during COVID-19.

This Special Issue aims to cover all aspects of respiratory assistance during COVID-19 with original information especially in the field of pathophysiology and clinical applications, but also in technological, organizational, and training innovations.

Prof. Dr. Guillaume Carteaux
Guest Editor

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Keywords

COVID-19 pathophysiology
respiratory support
translational research
mechanical ventilation
extracorporeal membrane oxygenation
patient-ventilator interaction
ventilatory device
innovation
training in artificial ventilation

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Published Papers (9 papers)

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Research

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13 pages, 1285 KiB

Open AccessArticle

Relationship of Extravascular Lung Water and Pulmonary Vascular Permeability to Respiratory Mechanics in Patients with COVID-19-Induced ARDS

by Florian Lardet, Xavier Monnet, Jean-Louis Teboul, Rui Shi, Christopher Lai, Quentin Fossé, Francesca Moretto, Thibaut Gobé, Ludwik Jelinski, Margot Combet, Arthur Pavot, Laurent Guérin and Tài Pham

J. Clin. Med. 2023, 12(5), 2028; https://doi.org/10.3390/jcm12052028 - 3 Mar 2023

Cited by 1 | Viewed by 2176

Abstract

During acute respiratory distress syndrome (ARDS), the increase in pulmonary vascular permeability and lung water induced by pulmonary inflammation may be related to altered lung compliance. A better understanding of the interactions between respiratory mechanics variables and lung water or capillary permeability would allow a more personalized monitoring and adaptation of therapies for patients with ARDS. Therefore, our main objective was to investigate the relationship between extravascular lung water (EVLW) and/or pulmonary vascular permeability index (PVPI) and respiratory mechanic variables in patients with COVID-19-induced ARDS. This is a retrospective observational study from prospectively collected data in a cohort of 107 critically ill patients with COVID-19-induced ARDS from March 2020 to May 2021. We analyzed relationships between variables using repeated measurements correlations. We found no clinically relevant correlations between EVLW and the respiratory mechanics variables (driving pressure (correlation coefficient [CI 95%]: 0.017 [−0.064; 0.098]), plateau pressure (0.123 [0.043; 0.202]), respiratory system compliance (−0.003 [−0.084; 0.079]) or positive end-expiratory pressure (0.203 [0.126; 0.278])). Similarly, there were no relevant correlations between PVPI and these same respiratory mechanics variables (0.051 [−0.131; 0.035], 0.059 [−0.022; 0.140], 0.072 [−0.090; 0.153] and 0.22 [0.141; 0.293], respectively). In a cohort of patients with COVID-19-induced ARDS, EVLW and PVPI values are independent from respiratory system compliance and driving pressure. Optimal monitoring of these patients should combine both respiratory and TPTD variables. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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11 pages, 261 KiB

Open AccessArticle

Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves

by Silvia Accordino, Ciro Canetta, Greta Bettini, Federica Corsico, Gabriele Ghigliazza, Laura Barbetta, Christian Folli, Valeria Savojardo and Francesco Blasi

J. Clin. Med. 2023, 12(4), 1562; https://doi.org/10.3390/jcm12041562 - 16 Feb 2023

Cited by 2 | Viewed by 1764

Abstract

Background: In COVID-19 patients non-invasive-positive-pressure-ventilation (NIPPV) has held a challenging role to reduce mortality and the need for invasive mechanical ventilation (IMV). The aim of this study was to compare the characteristics of patients admitted to a Medical Intermediate Care Unit for acute respiratory failure due to SARS-CoV-2 pneumonia throughout four pandemic waves. Methods: The clinical data of 300 COVID-19 patients treated with continuous positive airway pressure (CPAP) were retrospectively analysed, from March-2020 to April-2022. Results: Non-survivors were older and more comorbid, whereas patients transferred to ICU were younger and had fewer pathologies. Patients were older (from 65 (29–91) years in I wave to 77 (32–94) in IV, p < 0.001) and with more comorbidities (from Charlson’s Comorbidity Index = 3 (0–12) in I to 6 (1–12) in IV, p < 0.001). No statistical difference was found for in-hospital mortality (33.0%, 35.8%, 29.6% and 45.9% in I, II, III and IV, p = 0.216), although ICU-transfers rate decreased from 22.0% to 1.4%. Conclusions: COVID-19 patients have become progressively older and with more comorbidities even in critical care area; from risk class analyses by age and comorbidity burden, in-hospital mortality rates remain high and are thus consistent over four waves while ICU-transfers have significantly reduced. Epidemiological changes need to be considered to improve the appropriateness of care. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

11 pages, 987 KiB

Open AccessArticle

A Dedicated Expert ECMO-Team and Strict Patient Selection Improve Survival of Patients with Severe SARS-CoV-2 ARDS Supported by VV-ECMO

by Raphaël Giraud, Hannah Wozniak, Viviane Donner, Carole Looyens, Benjamin Assouline and Karim Bendjelid

J. Clin. Med. 2023, 12(1), 230; https://doi.org/10.3390/jcm12010230 - 28 Dec 2022

Viewed by 1915

Abstract

The SARS-CoV-2 pandemic has overwhelmed health care systems worldwide since its first wave. Intensive care units have been under a significant amount of pressure as patients with the most severe form of the disease presented with acute respiratory distress syndrome (ARDS). A proportion of them experienced refractory acute respiratory failure and had to be supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO). The present retrospective study reports the experiences of our ECMO center in the management of COVID-19 patients with refractory ARDS. Patient characteristics and outcomes are presented through the different waves of the pandemic. A cohort study was conducted on patients with refractory ARDS due to COVID-19 infection who were admitted to the intensive care unit (ICU) at the Geneva University Hospital and supported with VV-ECMO between 14 March 2020 and January 2022. The VV-ECMO implementation criteria were defined according to an institutional algorithm validated by the local crisis unit of the hospital and the Swiss Society of Intensive Care Medicine. Among the 500 ARDS patients admitted to our ICU, 41 patients with a median age of 57 (52–63) years, a body mass index (BMI) of 28 (26–32) kg/m², and a SAPS II score of 57 (47–67), and 27 (66%) of whom were men required VV-ECMO. None of the patients were vaccinated. The time of ventilation, including noninvasive ventilation (NIV) and mechanical ventilation (MV), and the time of MV before ECMO were 7 (4–11) days and 4 (1–7) days, respectively. The time under ECMO was 20 (10–27) days. The ICU and hospital lengths of stay were 36 (21–45) days and 45 (33–69) days, respectively. The survival rate for patients on ECMO was 59%. Comparative analysis between survivors and non-survivors highlighted that survivors had a significantly shorter ventilation duration before ECMO (NIV + MV: 5.5 (1.3–9) vs. 9 (6.5–13.5) days, p = 0.0026 and MV alone: 1.6 (0.4–5.5) vs. 5.8 (5–8) days, p < 0.0001). The management of patients on ECMO by an experienced ECMO team dedicated to this activity was associated with improved survival (78% vs. 28%, p = 0.0012). Between the first wave and the following waves, patients presented with a higher incidence of ventilator-associated pneumonia (100% vs. 82%, p = 0.0325) but had better survival rates (74% vs. 35%, p = 0.024). The present study suggests that both the prompt insertion of VV-ECMO to control refractory hypoxemia and the involvement of an ECMO team improve the survival of COVID-19 patients. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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17 pages, 3240 KiB

Open AccessArticle

Effectiveness of Hyperbaric Oxygen Therapy in SARS-CoV-2 Pneumonia: The Primary Results of a Randomised Clinical Trial

by Jacek Siewiera, Klaudia Brodaczewska, Natalia Jermakow, Arkadiusz Lubas, Krzysztof Kłos, Aleksandra Majewska and Jacek Kot

J. Clin. Med. 2023, 12(1), 8; https://doi.org/10.3390/jcm12010008 - 20 Dec 2022

Cited by 6 | Viewed by 3710

Abstract

Mortality in COVID-19 is mainly associated with respiratory failure, cytokine storm, and macrophage activation. Oxygenation and anti-inflammatory effects of Hyperbaric Oxygen Therapy (HBOT) suggest that it is a promising adjunct treatment for COVID-19. Repeated sessions of HBO with standard COVID-19 therapy were used to reduce the inflammation and increase oxygenation. We evaluated the safety and efficacy of HBOT in avoiding the replacement ventilation and/or ECMO and its effect on the inflammatory process. Twenty-eight moderate-to-severe COVID-19 patients were randomized into control or HBOT group. HBOT patients participated in 5 hyperbaric sessions (60 min). Before and after each session blood gas levels and vital parameters were monitored. Blood samples were collected for extended biochemical tests, blood morphology and immunological assays. There were 3 deaths in the control, no deaths in the HBOT group. No adverse events leading to discontinuation of HBOT were observed and patients receiving HBOT required lower oxygen delivery. We observed decrease in CRP, ferritin and LDH and increase in CD3 in HBOT group compared to control. This study confirmed the feasibility and safety of HBOT in patients with COVID-19 and indicated HBOT can lead to alleviation of inflammation and partial restoration of T cell responses. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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13 pages, 883 KiB

Open AccessArticle

Inhaled Sedation in Patients with COVID-19-Related Acute Respiratory Distress Syndrome: An International Retrospective Study

by Randy Coupet, Martin Schläpfer, Thomas A. Neff, Pierre Boucher, Pierre Bailly, Martin Bellgardt, Rafael Badenes, Jose Carbonell, Tobias Becher, Caroline Varillon, Dominique Morand, Raiko Blondonnet, Jean-Michel Constantin, Bruno Pereira, Brian O'Gara and Matthieu Jabaudon

J. Clin. Med. 2023, 12(1), 12; https://doi.org/10.3390/jcm12010012 - 20 Dec 2022

Cited by 4 | Viewed by 2181

Abstract

Background and objectives: The coronavirus disease 2019 (COVID-19) pandemic and the shortage of intravenous sedatives has led to renewed interest in inhaled sedation for patients with acute respiratory distress syndrome (ARDS). We hypothesized that inhaled sedation would be associated with improved clinical outcomes in COVID-19 ARDS patients. Methods: Retrospective international study including mechanically ventilated patients with COVID-19 ARDS who required sedation and were admitted to 10 European and US intensive care units. The primary endpoint of ventilator-free days through day 28 was analyzed using zero-inflated negative binomial regression, before and after adjustment for site, clinically relevant covariates determined according to the univariate results, and propensity score matching. Results: A total of 196 patients were enrolled, 78 of whom died within 28 days. The number of ventilator-free days through day 28 did not differ significantly between the patients who received inhaled sedation for at least 24 h (n = 111) and those who received intravenous sedation only (n = 85), with medians of 0 (interquartile range [IQR] 0–8) and 0 (IQR 0–17), respectively (odds ratio for having zero ventilator-free days through day 28, 1.63, 95% confidence interval [CI], 0.91–2.92, p = 0.10). The incidence rate ratio for the number of ventilator-free days through day 28 if not 0 was 1.13 (95% CI, 0.84–1.52, p = 0.40). Similar results were found after multivariable adjustment and propensity matching. Conclusion: The use of inhaled sedation in COVID-19 ARDS was not associated with the number of ventilator-free days through day 28. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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13 pages, 2285 KiB

Open AccessArticle

Remdesivir for Patients Hospitalized with COVID-19 Severe Pneumonia: A National Cohort Study (Remdeco-19)

by Jeremie Zerbit, Marion Detroit, Sylvie Chevret, Frederic Pene, Charles-Edouard Luyt, Jade Ghosn, Frederic Eyvrard, Guillaume Martin-Blondel, Benjamine Sarton, Raphael Clere-Jehl, Pierre Moine, Amelie Cransac, Pascal Andreu, Marie Labruyère, Laetitia Albertini, Jean-François Huon, Pauline Roge, Lise Bernard, Magali Farines-Raffoul, Maxime Villiet, Arnaud Venet, Louis Marie Dumont, Jean-Daniel Kaiser, Claire Chapuis, François Goehringer, François Barbier, Stephane Desjardins, Younes Benzidi, Nora Abbas, Corinne Guerin, Rui Batista, Jean-François Llitjos and Marie Kroemer Show full author list Hide full author list

J. Clin. Med. 2022, 11(21), 6545; https://doi.org/10.3390/jcm11216545 - 4 Nov 2022

Cited by 4 | Viewed by 1947

Abstract

Background. Given the rapidly evolving pandemic of COVID-19 in 2020, authorities focused on the repurposing of available drugs to develop timely and cost-effective therapeutic strategies. Evidence suggested the potential utility of remdesivir in the framework of an early access program. REMDECO-19 is a multicenter national cohort study assessing the ability of remdesivir to improve the outcome of patients hospitalized with COVID-19. Methods. We conducted a retrospective real-life study that included all patients from the early access program of remdesivir in France. The primary endpoint was the clinical course evolution of critically ill and hospitalized COVID-19 patients treated with remdesivir. Secondary endpoints were the SOFA score evolution within 29 days following the admission and mortality at 29 and 90 days. Results. Eighty-five patients were enrolled in 22 sites from January to April 2020. The median WHO and SOFA scores were respectively reduced by two and six points between days 1 and 29. Improvement in the WHO-CPS and the SOFA score were observed in 83.5% and 79.3% of patients, respectively, from day 10. However, there was no effect of remdesivir on the 90-day survival based on the control cohort for hospitalized COVID-19 patients with invasive ventilation. Conclusions. SOFA score appeared to be an attractive approach to assess remdesivir efficacy and stratify its utilization or not in critically ill patients with COVID-19. This study brings a new clinical benchmark for therapeutic decision making and supports the use of remdesivir for some hospitalized COVID-19 patients. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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8 pages, 352 KiB

Open AccessArticle

Outcomes of COVID-19 Patients with Severe Hypoxemic Acute Respiratory Failure: Non-Invasive Ventilation vs. Straight Intubation—A Propensity Score-Matched Multicenter Cohort Study

by Laura Pasin, Dario Gregori, Tommaso Pettenuzzo, Alessandro De Cassai, Annalisa Boscolo, Nicolò Sella, Giulia Lorenzoni, Federico Geraldini, Elisa Pistollato, Vito Marco Ranieri, Giovanni Landoni, Paolo Rosi, Paolo Navalesi and COVID-19 VENETO ICU Network

J. Clin. Med. 2022, 11(20), 6063; https://doi.org/10.3390/jcm11206063 - 14 Oct 2022

Cited by 2 | Viewed by 1792

Abstract

The best timing for endotracheal intubation in patients with coronavirus disease 2019 (COVID-19) hypoxemic acute respiratory failure (hARF) remains debated. Aim of this study is to compare the outcomes of COVID-19 patients with hARF receiving either a trial of non-invasive ventilation (NIV) or intubated with no prior attempt of NIV (“straight intubation”). All consecutive patients admitted to the 25 participating ICUs were included and divided in two groups: the “straight intubation” group and the “NIV” group. A propensity score matching was performed to correct for biases associated with the choice of the respiratory support. Primary outcome was in-hospital mortality. Secondary outcomes were length of mechanical ventilation, hospital stay and reintubation rate. A total of 704 COVID-19 patients were admitted to ICUs during the study period. After matching, 141 patients were included in each group. No clinically relevant difference at ICU admission was found between groups. In-hospital mortality was significantly lower in the NIV group (22.0% vs. 36.2%), with no significant difference in secondary endpoints. There was no significant mortality difference between patients who received straight intubation and those intubated after NIV failure. In COVID-19 patients with hARF it is worth and safe attempting a trial of NIV prior to intubation. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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12 pages, 1223 KiB

Open AccessArticle

Effects of a Chair Positioning Session on Awake Non-Intubated COVID-19 Pneumonia Patients: A Multicenter, Observational, and Pilot Study Using Lung Ultrasound

by Alexandre Lopez, Pierre Simeone, Louis Delamarre, Gary Duclos, Charlotte Arbelot, Ines Lakbar, Bruno Pastene, Karine Bezulier, Samuel Dahan, Emilie Joffredo, Lucille Jay, Lionel Velly, Bernard Allaouchiche, Sami Hraiech, Marc Leone and Laurent Zieleskiewicz

J. Clin. Med. 2022, 11(19), 5885; https://doi.org/10.3390/jcm11195885 - 5 Oct 2022

Cited by 2 | Viewed by 1713

Abstract

Background: LUS is a validated tool for the management of COVID-19 pneumonia. Chair positioning (CP) may have beneficial effects on oxygenation and lung aeration, and may be an easier alternative to PP. This study assessed the effects of a CP session on oxygenation and lung aeration (LA) changes in non-intubated COVID-19 patients. Methods: A retrospective multicenter study was conducted in an ICU. We analyzed data from LUS exams and SpO₂:FiO₂ performed before/after a CP session in non-intubated COVID-19 patients. Patients were divided into groups of responders or non-responders in terms of oxygenation or LA. Results: Thirty-three patients were included in the study; fourteen (44%) were oxygenation non-responders and eighteen (56%) were oxygenation responders, while thirteen (40.6%) and nineteen (59.4%) patients were classified as LA non-responders and responders, respectively. Changes in oxygenation and LA before/after a CP session were not correlated (r = −0.19, p = 0.3, 95% CI: −0.5–0.17). The reaeration scores did not differ between oxygenation responders and non-responders (1 (−0.75–3.75) vs. 4 (−1–6), p = 0.41). The LUS score was significantly correlated with SpO₂:FiO₂ before a CP session (r = 0.37, p = 0.04, 95% CI: 0.03–0.64) but not after (r = 0.17, p = 0.35, 95% CI: −0.19–0.50). Conclusion: A CP session was associated with improved oxygenation and LA in more than half of the non-intubated COVID-19 patients. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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Review

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18 pages, 1839 KiB

Open AccessReview

The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support

by Yorschua Jalil, Martina Ferioli and Martin Dres

J. Clin. Med. 2023, 12(10), 3486; https://doi.org/10.3390/jcm12103486 - 16 May 2023

Cited by 1 | Viewed by 1860

Abstract

During the COVID-19 pandemic, the use of non-invasive respiratory support (NIRS) became crucial in treating patients with acute hypoxemic respiratory failure. Despite the fear of viral aerosolization, non-invasive respiratory support has gained attention as a way to alleviate ICU overcrowding and reduce the risks associated with intubation. The COVID-19 pandemic has led to an unprecedented increased demand for research, resulting in numerous publications on observational studies, clinical trials, reviews, and meta-analyses in the past three years. This comprehensive narrative overview describes the physiological rationale, pre-COVID-19 evidence, and results of observational studies and randomized control trials regarding the use of high-flow nasal oxygen, non-invasive mechanical ventilation, and continuous positive airway pressure in adult patients with COVID-19 and associated acute hypoxemic respiratory failure. The review also highlights the significance of guidelines and recommendations provided by international societies and the need for further well-designed research to determine the optimal use of NIRS in treating this population. Full article

(This article belongs to the Special Issue COVID-19 Respiratory Support: Current Concept and Emerging Trends)

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