Mechanical ventilation in Covid-19: clinical lessons and challenges

Abstract

The use of mechanical ventilation (MV) in patients with Covid-19 was one of the main interventions in intensive care units (ICUs) during the pandemic, bringing major challenges to the management of critically ill patients, especially in the presence of acute respiratory distress syndrome (ARDS). Initially, a high mortality rate was observed among intubated patients, which led to a re-evaluation of the strategies used. Over time, the importance of individualizing MV was identified, since patients had different pulmonary patterns. The aim of this study is to demonstrate the lessons learned and clinical challenges faced by patients on MV during the Covid-19 pandemic. The study was carried out by searching the Medline/PubMed, Scientific Electronic Library Online (Scielo) and ScienceDirect databases. The research question and strategy used were based on the PICO model. Clinical trial studies, meta-analysis, randomized controlled trials, articles, books and documents published in English, Spanish and Portuguese in the last 5 years were included. A total of 147 articles were initially found. After analysis and elimination of duplicates, 133 references were analyzed by title and abstract, of which 65 were included for full reading. After this stage, 60 references were excluded. In the end, 5 studies were considered eligible. The available evidence showed that ventilatory management in COVID-19 required adaptation.