Universität zu Köln

Pfeifer, Michael, Ewig, Santiago, Voshaar, Thomas, Randerath, Winfried Johannes, Bauer, Torsten, Geiseler, Jens, Dellweg, Dominic, Westhoff, Michael, Windisch, Wolfram, Schoenhofer, Bernd, Kluge, Stefan and Lepper, PhilippM. (2020). Position Paper for the State-of-the-Art Application of Respiratory Support in Patients with COVID-19. Respiration, 99 (6). S. 521 - 542. BASEL: KARGER. ISSN 1423-0356

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Abstract

Against the background of the pandemic caused by infection with the SARS-CoV-2 virus, the German Respiratory Society has appointed experts to develop therapy strategies for COVID-19 patients with acute respiratory failure (ARF). Here we present key position statements including observations about the pathophysiology of (ARF). In terms of the pathophysiology of pulmonary infection with SARS-CoV-2, COVID-19 can be divided into 3 phases. Pulmonary damage in advanced COVID-19 often differs from the known changes in acute respiratory distress syndrome (ARDS). Two types (type L and type H) are differentiated, corresponding to early- and late-stage lung damage. This differentiation should be taken into consideration in the respiratory support of ARF. The assessment of the extent of ARF should be based on arterial or capillary blood gas analysis under room air conditions, and it needs to include the calculation of oxygen supply (measured from the variables of oxygen saturation, hemoglobin level, the corrected values of Hufner's factor, and cardiac output). Aerosols can cause transmission of infectious, virus-laden particles. Open systems or vented systems can increase the release of respirable particles. Procedures in which the invasive ventilation system must be opened and endotracheal intubation carried out are associated with an increased risk of infection. Personal protective equipment (PPE) should have top priority because fear of contagion should not be a primary reason for intubation. Based on the current knowledge, inhalation therapy, nasal high-flow therapy (NHF), continuous positive airway pressure (CPAP), or noninvasive ventilation (NIV) can be performed without an increased risk of infection to staff if PPE is provided. A significant proportion of patients with ARF present with relevant hypoxemia, which often cannot be fully corrected, even with a high inspired oxygen fraction (FiO(2)) under NHF. In this situation, the oxygen therapy can be escalated to CPAP or NIV when the criteria for endotracheal intubation are not met. In ARF, NIV should be carried out in an intensive care unit or a comparable setting by experienced staff. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring and readiness for intubation are to be ensured at all times. If the ARF progresses under CPAP/NIV, intubation should be implemented without delay in patients who do not have a do not intubate order. (c) 2020 S. Karger AG, Basel

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pfeifer, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Ewig, Santiago UNSPECIFIED UNSPECIFIED UNSPECIFIED Voshaar, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Randerath, Winfried Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Bauer, Torsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Geiseler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Dellweg, Dominic UNSPECIFIED UNSPECIFIED UNSPECIFIED Westhoff, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Windisch, Wolfram UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoenhofer, Bernd UNSPECIFIED UNSPECIFIED UNSPECIFIED Kluge, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Lepper, PhilippM. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-350194
DOI:	10.1159/000509104
Journal or Publication Title:	Respiration
Volume:	99
Number:	6
Page Range:	S. 521 - 542
Date:	2020
Publisher:	KARGER
Place of Publication:	BASEL
ISSN:	1423-0356
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EXTRACORPOREAL MEMBRANE-OXYGENATION; NONINVASIVE VENTILATION; INFLUENZA-VIRUS; MECHANICAL VENTILATION; DISTRESS-SYNDROME; GERMAN SOCIETY; PRESSURE VENTILATION; EXHALED BREATH; VIRAL LOAD; FAILURE Multiple languages Respiratory System Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/35019