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Solving the Mystery of COVID-19
Published in Srijan Goswami, Chiranjeeb Dey, COVID-19 and SARS-CoV-2, 2022
Usually, people try to manage the flu with medicines, and sometimes, there are chances for the virus to move down from the upper respiratory tract to the lower respiratory tract. As a result, breathing difficulty occurs and if checked with an oximeter, the oxygen level will be ≤ 90%. In such situations, the doctor will advise a ventilator because the lungs are full of water. What you have to do in such a situation is avoid going to the hospital because you will be put on a mechanical ventilator. You have to make your own ventilator at home. This is called prone ventilation (Guerin, 2014).
Clinical Rehabilitation of COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
Position management: Patients undergoing respiratory rehabilitation therapy should be guided to change position after discussion by the clinical treatment team. By raising the bed head to the half-lying position, gradually transition to the sitting position. Position therapy lasts for 30 minutes, three times a day. Patients with acute respiratory distress syndrome (ARDS) can use prone position > 12 hours a day to improve ventilation blood flow ratio, reduce pulmonary edema, increase functional residual volume, and reduce the possibility of intubation. Consider extracorporeal membrane oxygenation (ECMO) for poor prone ventilation. Turn over regularly, once every 1–2 hours. Lung recruitment is recommended for patients with severe ARDS.
Postoperative respiratory complications
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Manual of Neuroanesthesia, 2017
Zulfiqar Ali, Yasir N. Shah, Hemanshu Prabhakar
Pressure-controlled inverse ratio ventilation (PC-IRV) and ventilation in prone position may be used in refractory cases. In PC-IRV, the inspiratory time (I) is prolonged until it is equal to or greater than expiratory time (E), for example, using an I/E ratio of 1:1, 2:1, or 3:1. The physiological rationale of prone ventilation is that it optimizes lung recruitment and ventilation perfusion matching while preventing alveolar overinflation and allowing better postural drainage. Dramatic improvements in oxygenation are often observed in patients who are turned into the prone position for several hours, and this improvement may be sustained when they are returned to the supine position. The technique should be used for 12–24 h. However, there are practical difficulties in turning the critically ill patient and in nursing the patient in the prone position.
Interfacility Transport of Mechanically Ventilated Patients with Suspected COVID-19 in the Prone Position
Published in Prehospital Emergency Care, 2023
Andy Pan, Michael Peddle, Patrick Auger, Daryl Parfeniuk, Russell D. MacDonald
Prone positioning during mechanical ventilation in severe acute respiratory distress syndrome (ARDS) is an important intervention with both physiologic and empiric rationale for its use. The PROSEVA trial (1) and subsequent meta-analyses (2, 3) support prone positioning as an effective therapy to reduce mortality in severe ARDS, particularly when applied early and when used with other lung-protective strategies. Prone ventilation is believed to improve ventilation-perfusion matching and alveolar recruitment, and may help redistribute extravascular fluid (4). Lung-protective ventilation and prone position ventilation proved to be essential components of ventilation management at the initial epicenter of the COVID-19 outbreak in Wuhan, China (5). Multiple organizations, including The Society for Critical Care Medicine and The European Society of Intensive Care Medicine (6), strongly recommend prone positioning for more than 12 hours per day in patients with refractory hypoxemia due to ARDS.
Critical care
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2021
Ricardo Teijeiro Paradis, Ghislaine Douflé, John Granton
Features that set COVID related ARDS apart from historical causes of ARDS include a high rate of thrombotic complications and delayed onset from start of infection. We are only starting to appreciate the long-term sequelae of infection. It is unclear if fibrocavitary disease is more common in COVID-19 as it may only reflect the higher prevalence of ARDS in the face of a pandemic than previous seasonal influenza or other infectious etiologies. Although initial literature portraying COVID-19 respiratory failure as having distinct pathophysiological differences from other types of ARDS, the fundamentals in the treatment of COVID ARDS have not changed and remain supportive. A focus on the use of lung protection strategies, including reduction of tidal volumes and prone ventilation remain central to care.
COVID-19 infection and its deadly cytokine storm in a young obese adult
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Sundas Abbas, Ayaz Ahmad, Alexandre Lacasse
On presentation, she had high-grade fever of 103 F as well as tachypnea and hypoxemia requiring 3 L/min of supplemental oxygen via nasal cannula. On examination, diffuse pulmonary wheezing was present. BMI was recorded as 62.61 kg/m2. Imaging showed bilateral diffuse ground glass pulmonary infiltrates (Figure 1 and Figure 2). Laboratory parameters showed mild lymphopenia with normal total white blood cell count, normal platelet count, mild transaminitis, acute kidney injury as well as elevated C-reactive protein, ferritin, LDH and D-dimer but low procalcitonin. Interleukin-6 levels were markedly elevated to 76 pg/ml (Table 1). Nasopharyngeal respiratory pathogen PCR panel was negative. Nasopharyngeal SARS-CoV-2 viral PCR was positive. The patient remained on supplemental oxygen replacement. Rapidly progressive hypoxemia ensued necessitating intubation and mechanical ventilatory support within 16 hours of presentation. Hydroxychloroquine and azithromycin were initiated. Significant-elevated positive-end-expiratory pressure and fraction of inspired oxygen were required for acceptable oxygenation consistent with ARDS. Prone ventilation attempts were unsuccessful. Tocilizumab, an interleukin (IL)-6 antagonist, was administered on day 3. IL-6 serum levels were significantly elevated, consistent with the cytokine release syndrome as the underlying mechanism of lung injury. Given shock and vasopressor-dependency, compassionate use of a novel anti-viral drug, Remdesivir, was not possible. Refractory hypoxemia subsequently led to the patient’s demise.