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Increased physiological dead space in mechanically ventilated COVID-19 patients recovering from severe acute respiratory distress syndrome: a case report.
BMC Infect Dis. 2020 Aug 27; 20(1):637.BI

Abstract

BACKGROUND

An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally. Recently, several articles have mentioned that the early acute respiratory distress syndrome (ARDS) caused by COVID-19 significantly differ from those of ARDS due to other causes. Actually, we newly observed that some mechanically ventilated COVID-19 patients recovering from severe ARDS (more than 14 days after invasive ventilation) often experienced evidently gradual increases in CO2 retention and minute ventilation. However, the underlying mechanics remain unclear.

CASE PRESENTATION

To explain these pathophysiological features and discuss the ventilatory strategy during the late phase of severe ARDS in COVID-19 patients, we first used a metabolic module on a General Electric R860 ventilator (Engstrom Carestation; GE Healthcare, USA) to monitor parameters related to gas metabolism, lung mechanics and physiological dead space in two COVID-19 patients. We found that remarkably decreased ventilatory efficiency (e.g., the ratio of dead space to tidal volume 70-80%, arterial to end-tidal CO2 difference 18-23 mmHg and ventilatory ratio 3-4) and hypermetabolism (oxygen consumption 300-400 ml/min, CO2 elimination 200-300 ml/min) may explain why these patients experienced more severe respiratory distress and CO2 retention in the late phase of ARDS caused by COVID-19.

CONCLUSION

During the recovery period of ARDS among mechanically-ventilated COVID-19 patients, attention should be paid to the monitoring of physiological dead space and metabolism. Tidal volume (8-9 ml/kg) could be increased appropriately under the limited plateau pressure; however, barotrauma should still be kept in mind.

Authors+Show Affiliations

Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.Department of Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing, 100029, China.Department of Pulmonary and Critical Care Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China. drzhanqy@163.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

32854630

Citation

Xia, Jingen, et al. "Increased Physiological Dead Space in Mechanically Ventilated COVID-19 Patients Recovering From Severe Acute Respiratory Distress Syndrome: a Case Report." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 637.
Xia J, Feng Y, Li M, et al. Increased physiological dead space in mechanically ventilated COVID-19 patients recovering from severe acute respiratory distress syndrome: a case report. BMC Infect Dis. 2020;20(1):637.
Xia, J., Feng, Y., Li, M., Yu, X., Zhang, Y., Duan, J., & Zhan, Q. (2020). Increased physiological dead space in mechanically ventilated COVID-19 patients recovering from severe acute respiratory distress syndrome: a case report. BMC Infectious Diseases, 20(1), 637. https://doi.org/10.1186/s12879-020-05360-5
Xia J, et al. Increased Physiological Dead Space in Mechanically Ventilated COVID-19 Patients Recovering From Severe Acute Respiratory Distress Syndrome: a Case Report. BMC Infect Dis. 2020 Aug 27;20(1):637. PubMed PMID: 32854630.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased physiological dead space in mechanically ventilated COVID-19 patients recovering from severe acute respiratory distress syndrome: a case report. AU - Xia,Jingen, AU - Feng,Yingying, AU - Li,Min, AU - Yu,Xin, AU - Zhang,Yi, AU - Duan,Jun, AU - Zhan,Qingyuan, Y1 - 2020/08/27/ PY - 2020/04/30/received PY - 2020/08/19/accepted PY - 2020/8/29/entrez PY - 2020/8/29/pubmed PY - 2020/9/2/medline KW - Acute respiratory distress syndrome KW - Case report KW - Coronavirus disease 2019 KW - Dead space ventilation KW - Mechanical ventilation SP - 637 EP - 637 JF - BMC infectious diseases JO - BMC Infect Dis VL - 20 IS - 1 N2 - BACKGROUND: An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally. Recently, several articles have mentioned that the early acute respiratory distress syndrome (ARDS) caused by COVID-19 significantly differ from those of ARDS due to other causes. Actually, we newly observed that some mechanically ventilated COVID-19 patients recovering from severe ARDS (more than 14 days after invasive ventilation) often experienced evidently gradual increases in CO2 retention and minute ventilation. However, the underlying mechanics remain unclear. CASE PRESENTATION: To explain these pathophysiological features and discuss the ventilatory strategy during the late phase of severe ARDS in COVID-19 patients, we first used a metabolic module on a General Electric R860 ventilator (Engstrom Carestation; GE Healthcare, USA) to monitor parameters related to gas metabolism, lung mechanics and physiological dead space in two COVID-19 patients. We found that remarkably decreased ventilatory efficiency (e.g., the ratio of dead space to tidal volume 70-80%, arterial to end-tidal CO2 difference 18-23 mmHg and ventilatory ratio 3-4) and hypermetabolism (oxygen consumption 300-400 ml/min, CO2 elimination 200-300 ml/min) may explain why these patients experienced more severe respiratory distress and CO2 retention in the late phase of ARDS caused by COVID-19. CONCLUSION: During the recovery period of ARDS among mechanically-ventilated COVID-19 patients, attention should be paid to the monitoring of physiological dead space and metabolism. Tidal volume (8-9 ml/kg) could be increased appropriately under the limited plateau pressure; however, barotrauma should still be kept in mind. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/32854630/Increased_physiological_dead_space_in_mechanically_ventilated_COVID_19_patients_recovering_from_severe_acute_respiratory_distress_syndrome:_a_case_report_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05360-5 DB - PRIME DP - Unbound Medicine ER -