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 protoc...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 cmH2 O of positive end-expiratory pressure;respiratory rate,20 breaths/min;and 40%-80%FiO2]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.展开更多
文摘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 cmH2 O of positive end-expiratory pressure;respiratory rate,20 breaths/min;and 40%-80%FiO2]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.
