tetano
Editor, Senior Moderator
World J Clin Cases
. 2020 Aug 6;8(15):3305-3313.
doi: 10.12998/wjcc.v8.i15.3305.
Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports
Mian Peng[SUP] 1 [/SUP], Di Ren[SUP] 2 [/SUP], Yong-Feng Liu[SUP] 3 [/SUP], Xi Meng[SUP] 4 [/SUP], Ming Wu[SUP] 5 [/SUP], Rong-Lin Chen[SUP] 3 [/SUP], Bao-Jun Yu[SUP] 6 [/SUP], Long-Cheng Tao[SUP] 1 [/SUP], Li Chen[SUP] 1 [/SUP], Zeng-Qiao Lai[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases.
Case summary: Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients' respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH[SUB]2[/SUB]O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO[SUB]2[/SUB]] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well.
Conclusion: A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.
Keywords: COVID-19; Case report; Mechanically ventilated cases; Sequential weaning protocol.
. 2020 Aug 6;8(15):3305-3313.
doi: 10.12998/wjcc.v8.i15.3305.
Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports
Mian Peng[SUP] 1 [/SUP], Di Ren[SUP] 2 [/SUP], Yong-Feng Liu[SUP] 3 [/SUP], Xi Meng[SUP] 4 [/SUP], Ming Wu[SUP] 5 [/SUP], Rong-Lin Chen[SUP] 3 [/SUP], Bao-Jun Yu[SUP] 6 [/SUP], Long-Cheng Tao[SUP] 1 [/SUP], Li Chen[SUP] 1 [/SUP], Zeng-Qiao Lai[SUP] 1 [/SUP]
Affiliations
- PMID: 32874986
- PMCID: PMC7441264
- DOI: 10.12998/wjcc.v8.i15.3305
Abstract
Background: Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases.
Case summary: Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients' respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH[SUB]2[/SUB]O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO[SUB]2[/SUB]] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well.
Conclusion: A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19.
Keywords: COVID-19; Case report; Mechanically ventilated cases; Sequential weaning protocol.