Two mechanically ventilated cases of COVID-19 successfully managed with a sequential ventilation weaning protocol: Two case reports
| Autor: | Di Ren, Zeng-Qiao Lai, Rong-Lin Chen, Bao-Jun Yu, Xi Meng, Long-Cheng Tao, Mian Peng, Li Chen, Yong-Feng Liu, Ming Wu |
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| Rok vydání: | 2020 |
| Předmět: |
Protocol (science)
2019-20 coronavirus outbreak medicine.medical_specialty Coronavirus disease 2019 (COVID-19) business.industry Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 General Medicine Mechanically ventilated cases law.invention Sequential weaning protocol 03 medical and health sciences 0302 clinical medicine law 030220 oncology & carcinogenesis Case report Ventilation (architecture) Emergency medicine Medicine Weaning 030211 gastroenterology & hepatology business |
| Zdroj: | World Journal of Clinical Cases |
| ISSN: | 2307-8960 |
| DOI: | 10.12998/wjcc.v8.i15.3305 |
| Popis: | BACKGROUND Patients with critical coronavirus disease 2019 (COVID-19), characterized by respiratory failure requiring mechanical ventilation (MV), are at high risk of mortality. An effective and practical MV weaning protocol is needed for these fragile cases. CASE SUMMARY Here, we present two critical COVID-19 patients who presented with fever, cough and fatigue. COVID-19 diagnosis was confirmed based on blood cell counts, chest computed tomography (CT) imaging, and nuclei acid test results. To address the patients’ respiratory failure, they first received noninvasive ventilation (NIV). When their condition did not improve after 2 h of NIV, each patient was advanced to MV [tidal volume (Vt), 6 mL/kg ideal body weight (IBW); 8-10 cmH2O of positive end-expiratory pressure; respiratory rate, 20 breaths/min; and 40%-80% FiO2] with prone positioning for 12 h/day for the first 5 d of MV. Extensive infection control measures were conducted to minimize morbidity, and pharmacotherapy consisting of an antiviral, immune-enhancer, and thrombosis prophylactic was administered in both cases. Upon resolution of lung changes evidenced by CT, the patients were sequentially weaned using a weaning screening test, spontaneous breathing test, and airbag leak test. After withdrawal of MV, the patients were transitioned through NIV and high-flow nasal cannula oxygen support. Both patients recovered well. CONCLUSION A MV protocol attentive to intubation/extubation timing, prone positioning early in MV, infection control, and sequential withdrawal of respiratory support, may be an effective regimen for patients with critical COVID-19. |
| Databáze: | OpenAIRE |
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