What are the pulmonary ventilation strategies in the acute respiratory distress syndrome caused by COVID-19? A review study





COVID-19; Betacoronavirus; Respiration artificial; Respiratory distress syndrome adult.


In late 2019, a group of pneumonia cases associated with a new enveloped RNA coronavirus, spreading rapidly across continents and being known as the global COVID-19 pandemic. A smaller part of the population will not require hospitalization, however, some patients may develop a severe form of the disease and present complications such as an acute respiratory distress syndrome (ARDS) that requires invasive mechanical ventilation (IMV). Patients with ARDS by COVID-19 may present some specific characteristics in comparison with the typical forms of the syndrome, developing distinct phenotypes that have still been studied. Research has focused on clarifying protective lung ventilation (PLV) for these patients. This narrative review aimed to investigate the current worldwide experience in relation to PLV as management of ARDS associated with COVID-19 and to highlight IMV practices during a pandemic. After a process of tracking studies in the PubMed and BVS databases, 20 studies were selected. In most studies, the ventilatory management of patients is similar to the “classic” ARDS and, therefore, an PLV stood out as an important ally in the regression of ARDS in COVID-19 patients. However, the patients' phenotypic heterogeneity must be taken into account, especially regarding pulmonary mechanics and recruitment capacity. This study enabled scientific deepening of the similarities and differences of ARDS due to COVID-19 and other causes, in addition to allowing the formation of guidelines regarding initial ventilatory adjustments in patients with ARDS / COVID-19.


Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E.,. & Rhodes, A. (2020). Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive care medicine, 1-34. https://doi.org/10.1007/s00134-020-06022-5

Amato, M. B., Meade, M. O., Slutsky, A. S., Brochard, L., Costa, E. L., Schoenfeld, D. A., & Brower, R. G. (2015). Driving pressure and survival in the acute respiratory distress syndrome. New England Journal of Medicine, 372(8), 747-755. https://doi.org//10.1056/NEJMsa1410639

Auld, S., Caridi-Scheible, M., Blum, J. M., Robichaux, C. J., Kraft, C. S., Jacob, J. T., & COVID, E. (2020). ICU and ventilator mortality among critically ill adults with COVID-19. medRxiv. https://doi.org/10.1101/2020.04.23.20076737

Barbas, C. S. V., Ísola, A. M., Farias, A. M. D. C., Cavalcanti, A. B., Gama, A. M. C., Duarte, A. C. M., & Amado, V. M. (2014). Recomendações brasileiras de ventilação mecânica 2013. Parte I. Revista Brasileira de terapia intensiva, 26(2), 89-121. https://doi.org/10.5935/0103-507X.20140017

Cavayas, Y. A., Noël, A., Brunette, V., Williamson, D., Frenette, A. J., Arsenault, C., & Albert, M. (2020). Early experience with critically ill patients with COVID-19 in Montreal. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 1-10. https://doi.org/10.1007/s12630-020-01816-z

Chao, J. Y., Derespina, K. R., Herold, B. C., Goldman, D. L., Aldrich, M., Weingarten, J., & Medar, S. S. (2020). Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 (COVID-19) at a Tertiary Care Medical Center in New York City. The Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2020.05.006

Cummings, M. J., Baldwin, M. R., Abrams, D., Jacobson, S. D., Meyer, B. J., Balough, E. M., & O'Donnell, M. R. (2020). Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. The Lancet. https://doi.org/10.1016/S0140-6736(20)31189-2

De Prost, N., Ricard, J. D., Saumon, G., & Dreyfuss, D. (2011). Ventilator-induced lung injury: historical perspectives and clinical implications. Annals of intensive care, 1(1), 1-15. https://doi.org/10.1186/2110-5820-1-28

Derespina, K. R., Kaushik, S., Plichta, A., Conway Jr, E. E., Bercow, A., Choi, J., & Medar, S. S. (2020). Clinical manifestations and outcomes of critically ill children and adolescents with coronavirus disease 2019 in New York city. The Journal of pediatrics, 226, 55-63. https://doi.org/10.1016/j.jpeds.2020.07.039

Evrard, B., Goudelin, M., Montmagnon, N., Fedou, A. L., Lafon, T., & Vignon, P. (2020). Cardiovascular phenotypes in ventilated patients with COVID-19 acute respiratory distress syndrome. Critical Care, 24(1), 1-5. https://doi.org/10.1186/s13054-020-02958-8

Fan, E., Beitler, J. R., Brochard, L., Calfee, C. S., Ferguson, N. D., Slutsky, A. S., & Brodie, D. (2020). COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?. The Lancet Respiratory Medicine. https://doi.org/10.1016/S2213-2600(20)30304-0

Ferrando, C., Suarez-Sipmann, F., Mellado-Artigas, R., Hernández, M., Gea, A., Arruti, E., & Villar, J. (2020). Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive care medicine, 46(12), 2200-2211. https://doi.org/10.1007/s00134-020-06192-2

Gamberini, L., Tonetti, T., Spadaro, S., Zani, G., Mazzoli, C. A., Capozzi, C., & Ranieri, V. M. (2020). Factors influencing liberation from mechanical ventilation in coronavirus disease 2019: multicenter observational study in fifteen Italian ICUs. Journal of intensive care, 8(1), 1-12. https://doi.org/10.1186/s40560-020-00499-4

Garcia, P. D. W., Fumeaux, T., Guerci, P., Heuberger, D. M., Montomoli, J., Roche-Campo, F., & RISC-19-ICU Investigators. (2020). Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort. EClinicalMedicine, 25, 100449. https://doi.org/10.1016/j.eclinm.2020.100449

Gattinoni, L., Chiumello, D., Caironi, P., Busana, M., Romitti, F., Brazzi, L., & Camporota, L. (2020). COVID-19 pneumonia: different respiratory treatments for different phenotypes?. https://doi.org/10.1007/s00134-020-06033-2

Gattinoni, L., Coppola, S., Cressoni, M., Busana, M., Rossi, S., & Chiumello, D. (2020). Covid-19 does not lead to a “typical” acute respiratory distress syndrome. American journal of respiratory and critical care medicine, 201(10), 1299-1300. https://doi.org/10.1164/rccm.202003-0817LE

Ge, H., Pan, Q., Zhou, Y., Xu, P., Zhang, L., Zhang, J., & Zhang, Z. (2020). Lung Mechanics of Mechanically Ventilated Patients With COVID-19: Analytics With High-Granularity Ventilator Waveform Data. Frontiers in medicine, 7, 541. https://doi.org/10.3389/fmed.2020.00541

Grasselli, G., Greco, M., Zanella, A., Albano, G., Antonelli, M., Bellani, G., & Cecconi, M. (2020). Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA internal medicine, 180(10), 1345-1355. https://doi.org/10.1001/jamainternmed.2020.3539

Grasselli, G., Zangrillo, A., Zanella, A., Antonelli, M., Cabrini, L., Castelli, A., & Pesenti, A. (2020). Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. Jama, 323(16), 1574-1581. https://doi.org/10.1001/jama.2020.5394

Hernandez-Romieu, A. C., Adelman, M. W., Hockstein, M. A., Robichaux, C. J., Edwards, J. A., Fazio, J. C., & Auld, S. C. (2020). Timing of intubation and mortality among critically ill coronavirus disease 2019 patients: a single-center cohort study. Critical care medicine. https:// doi.org/10.1097/CCM.0000000000004600

Kokoszka-Bargieł, I., Cyprys, P., Rutkowska, K., Madowicz, J., & Knapik, P. (2020). Intensive Care Unit Admissions During the First 3 Months of the COVID-19 Pandemic in Poland: A Single-Center, Cross-Sectional Study. Medical science monitor: international medical journal of experimental and clinical research, 26, e926974-1. https:// doi.org/10.12659/MSM.926974

Liu, X., Liu, X., Xu, Y., Xu, Z., Huang, Y., Chen, S., & Li, Y. (2020). Ventilatory Ratio in Hypercapnic Mechanically Ventilated Patients with COVID-19–associated Acute Respiratory Distress Syndrome. American journal of respiratory and critical care medicine, 201(10), 1297-1299. https://doi.org/10.1164/rccm.202002-0373LE

Mauri, T., Spinelli, E., Scotti, E., Colussi, G., Basile, M. C., Crotti, S., & Pesenti, A. (2020). Potential for lung recruitment and ventilation-perfusion mismatch in patients with the acute respiratory distress syndrome from coronavirus disease 2019. Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000004386

Mittermaier, M., Pickerodt, P., Kurth, F., de Jarcy, L. B., Uhrig, A., Garcia, C., & Müller-Redetzky, H. (2020). Evaluation of PEEP and prone positioning in early COVID-19 ARDS. EClinicalMedicine, 28, 100579. https://doi.org/10.1016/j.eclinm.2020.100579

Monteiro, A. C., Suri, R., Emeruwa, I. O., Stretch, R. J., Cortes-Lopez, R. Y., Sherman, A., & Qadir, N. (2020). Obesity and smoking as risk factors for invasive mechanical ventilation in COVID-19: a retrospective, observational cohort study. PloS one, 15(12), e0238552. https://doi.org/10.1371/journal.pone.0238552

Pan, C., Chen, L., Lu, C., Zhang, W., Xia, J. A., Sklar, M. C., & Qiu, H. (2020). Lung Recruitability in COVID-19–associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study. American journal of respiratory and critical care medicine, 201(10), 1294-1297. https://doi.org/10.1164/rccm.202003-0527LE

Pereira, A. S., Shitsuka, D. M., Parreira, F. J., Shitsuka, R. 2018. Metodologia da pesquisa científica [e-book]. Santa Maria, RS. 1 Ed. UAB/NTE/UFSM

Pistillo, N., & Fariña, O. (2018). Driving airway and transpulmonary pressure are correlated to VILI determinants during controlled ventilation. Intensive care medicine, 44(5), 674-675. https://doi.org/10.1007/s00134-018-5092-1

Primmaz, S., Le Terrier, C., Suh, N., Ventura, F., Boroli, F., Bendjelid, K., & Pugin, J. (2020). Preparedness and reorganization of care for coronavirus disease 2019 patients in a swiss ICU: characteristics and outcomes of 129 patients. Critical care explorations, 2(8). https://doi.org/10.1097/CCE.0000000000000173

Saida, I. B., Ennouri, E., Nachi, R., Meddeb, K., Mahmoud, J., Thabet, N., & Boussarsar, M. (2020). Very severe COVID-19 in the critically ill in Tunisia. The Pan African Medical Journal, 35(Suppl 2). https://doi.org/10.11604/pamj.supp.2020.35.136.24753

Schmidt, M., Hajage, D., Demoule, A., Pham, T., Combes, A., Dres, M., & Grégoire, C. (2020). Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Medicine. https://doi.org/10.1007/s00134-020-06294-x

Slutsky, A. S., & Ranieri, V. M. (2014). Ventilator-induced lung injury. The New England journal of medicine, 370(10), 980-980. https://doi.org/10.1056/nejmc1400293

Turgut, T. E. K. E., KARS, T. U., & KOLLU, K. Ventilatory Management Strategies For Acute Respiratory Distress Syndrome (Ards) Due To Covid-19 Disease. Eurasian Journal of Critical Care, 2(2), 171-182.

Weiss, T. T., Cerda, F., Scott, J. B., Kaur, R., Sungurlu, S., Mirza, S. H., & Li, J. (2020). Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. British journal of anaesthesia. https://doi.org/10.1016/j.bja.2020.09.042

World Health Organization. (2020). WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int/

Yang, X., Yu, Y., Xu, J., Shu, H., Liu, H., Wu, Y., & Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. https://doi.org/10.1016/S2213-2600(20)30079-5

Yoshida, T., Fujino, Y., Amato, M. B., & Kavanagh, B. P. (2017). Fifty years of research in ARDS. Spontaneous breathing during mechanical ventilation. Risks, mechanisms, and management. American journal of respiratory and critical care medicine, 195(8), 985-992. https://doi.org/10.1164/rccm.201604-0748CP

Ziehr, D. R., Alladina, J., Petri, C. R., Maley, J. H., Moskowitz, A., Medoff, B. D., & Hardin, C. C. (2020). Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study. American Journal of Respiratory and Critical Care Medicine, (ja). https://doi.org/10.1164/rccm.202004-1163LE

Bellani, G., Grassi, A., Sosio, S., Gatti, S., Kavanagh, B. P., Pesenti, A., & Foti, G. (2019). Driving pressure is associated with outcome during assisted ventilation in acute respiratory distress syndrome. Anesthesiology: The Journal of the American Society of Anesthesiologists, 131(3), 594-604. https://doi.org/10.1097/ALN.0000000000002846

Villar, J., Martín-Rodríguez, C., Domínguez-Berrot, A. M., Fernández, L., Ferrando, C., Soler, J. A., & Kacmarek, R. M. (2017). A quantile analysis of plateau and driving pressures: effects on mortality in patients with acute respiratory distress syndrome receiving lung-protective ventilation. Critical care medicine, 45(5), 843-850. https://doi.org/10.1097/CCM.0000000000002330

Force, A. D. T., Ranieri, V. M., Rubenfeld, G. D., Thompson, B. T., Ferguson, N. D., & Caldwell, E. (2012). Acute respiratory distress syndrome. Jama, 307(23), 2526-2533. https://doi.org/10.1001/jama.2012.5669



How to Cite

OLIVEIRA, M. I. da S. .; BRANDÃO, C. B. F. .; COSTA, K. V. da .; SILVA, J. P. dos S. .; FERNANDES, V. M. de S. .; BRITO, G. E. G. de .; ELIHIMAS JÚNIOR, U. F. .; FRANÇA, E. E. T. de . What are the pulmonary ventilation strategies in the acute respiratory distress syndrome caused by COVID-19? A review study. Research, Society and Development, [S. l.], v. 10, n. 1, p. e51110112037, 2021. DOI: 10.33448/rsd-v10i1.12037. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/12037. Acesso em: 1 mar. 2021.



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