During her PhD research at the University of Amsterdam, Anissa Tsonsas investigated the ways in which COVID-19 patients were invasively provided with ventilation, especially during the first wave of the pandemic in the Netherlands. She also studied associations with the outcomes.
COVID-19 can cause acute respiratory failure, requiring invasive ventilation. At the beginning of the pandemic, there was no evidence of how best to ventilate this particular population.
The following five cases were investigated: 1) COVID-19 patients were on a ventilator in a similar way to patients with ARDS of other origin; 2) ventilation policy was associated with the outcomes of invasively ventilated COVID-19 patients; 3) a strategy with a lower positive end-expiratory pressure (PEEP) is inferior to a higher PEEP strategy; 4) hypercapnia and hyperoxemia are common and associated with outcome; and 5) timing of tracheostomy is associated with outcome.
Tsonsas’ first major finding was that lung protective ventilation was very well applied in COVID-19 patients requiring invasive ventilation. In addition, the use of a lower tidal volume was associated with a lower mortality.
The same questions remain open about invasive ventilation in COVID-19 patients as in patients with ARDS of other causes, for example about the appropriate use of PEEP, blood gas analysis values and the optimal timing of tracheostomy.
Bron:
Tsonas AM. Aspects of ventilation management and clinical outcomes in COVID-19 patients. Dissertation, University of Amsterdam, June 8, 2022.
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