High Respiratory Drive and Excessive Respiratory Efforts Predict Relapse of Respiratory Failure in Critically Ill Patients with COVID-19

Esnault, Pierre; Cardinale, Michaël; Hraiech, Sami; Goutorbe, Philippe; Baumstrack, Karine; Prud’Homme, Eloi; Bordes, Julien; Forel, Jean Marie; Meaudre, Éric; Papazian, Laurent; Guervilly, Christophe

doi:10.1164/rccm.202005-1582le

Cited by 91 publications

(85 citation statements)

References 12 publications

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“…Recently, a study evaluated airway occlusion pressure (P01), a surrogate measure of respiratory drive, in mechanically ventilated COVID-19 patients. In this cohort of patients, P01 was frequently above 4 cm H 2 O, suggesting high neuronal respiratory drive, high respiratory effort, and excessive respiratory muscles load [ 44 ]. It has been described that COVID-19 patients can maintain a (pseudo)normal respiratory rate despite an increase in inspiratory effort, thus indicating that PL and inspiratory effort cannot be estimated by the individual’s breathing frequency [ 45 , 46 , 47 , 48 , 49 ].…”

Section: The Role Of Spontaneous Breathing In Covid-19-related Lunmentioning

confidence: 99%

Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario

Tonelli

Marchioni

Tabbì

et al. 2021

JCM

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The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual’s excessive spontaneous breathing may acquire critical importance, being one potential and important driver of lung injury and disease progression. The consequences of this acute lung damage may impair lung structure, forecasting the model of a fragile respiratory system. This perspective article aims to analyze the progression of injured lung phenotypes across the SARS-CoV-2 induced respiratory failure, pointing out the role of spontaneous breathing and also tackling the specific respiratory/ventilatory strategy required by the fragile lung type.

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Section: The Role Of Spontaneous Breathing In Covid-19-related Lunmentioning

confidence: 99%

Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario

Tonelli

Marchioni

Tabbì

et al. 2021

JCM

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“…Therefore, adequate regulation of spontaneous breathing has been increasingly recognized as important in respiratory management in ARDS. It would be important to systematically measure the respiratory drive in ventilated patients making spontaneous breathing and to assess how high respiratory drive leads to subsequent deterioration of respiratory function during attempts to weaning from mechanical ventilation [ 7 ].…”

Section: Respiratory Drive and Effortmentioning

confidence: 99%

Oxygen administration for patients with ARDS

Ohshimo

2021

j intensive care

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Acute respiratory distress syndrome (ARDS) is a fatal condition with insufficiently clarified etiology. Supportive care for severe hypoxemia remains the mainstay of essential interventions for ARDS. In recent years, adequate ventilation to prevent ventilator-induced lung injury (VILI) and patient self-inflicted lung injury (P-SILI) as well as lung-protective mechanical ventilation has an increasing attention in ARDS.Ventilation-perfusion mismatch may augment severe hypoxemia and inspiratory drive and consequently induce P-SILI. Respiratory drive and effort must also be carefully monitored to prevent P-SILI. Airway occlusion pressure (P0.1) and airway pressure deflection during an end-expiratory airway occlusion (Pocc) could be easy indicators to evaluate the respiratory drive and effort. Patient-ventilator dyssynchrony is a time mismatching between patient’s effort and ventilator drive. Although it is frequently unrecognized, dyssynchrony can be associated with poor clinical outcomes. Dyssynchrony includes trigger asynchrony, cycling asynchrony, and flow delivery mismatch. Ventilator-induced diaphragm dysfunction (VIDD) is a form of iatrogenic injury from inadequate use of mechanical ventilation. Excessive spontaneous breathing can lead to P-SILI, while excessive rest can lead to VIDD. Optimal balance between these two manifestations is probably associated with the etiology and severity of the underlying pulmonary disease.High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NPPV) are non-invasive techniques for supporting hypoxemia. While they are beneficial as respiratory supports in mild ARDS, there can be a risk of delaying needed intubation. Mechanical ventilation and ECMO are applied for more severe ARDS. However, as with HFNC/NPPV, inappropriate assessment of breathing workload potentially has a risk of delaying the timing of shifting from ventilator to ECMO. Various methods of oxygen administration in ARDS are important. However, it is also important to evaluate whether they adequately reduce the breathing workload and help to improve ARDS.

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“…Clinical concerns include rapid deterioration of respiratory failure requiring mechanical ventilation, high mortality, and the possibility of reinfection after a successful recovery. 1 Recently, COVID-19 relapse after transient improvement has emerged as a clinically relevant issue 2 , 3 , 4 ; reports suggest that COVID-19-related inflammation can remain even when patients have seemingly improved. Previous studies showed that the degree of lymphopenia and the levels of anti-SARS-CoV-2 antibodies were dependent on disease severity.…”

Section: To the Editormentioning

confidence: 99%

Predicting recurrence of respiratory failure in critically ill patients with COVID-19: A preliminary study

Shiroyama

Yamaguchi

Murakami

et al. 2021

Journal of Infection

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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High Respiratory Drive and Excessive Respiratory Efforts Predict Relapse of Respiratory Failure in Critically Ill Patients with COVID-19

Cited by 91 publications

References 12 publications

Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario

Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario

Oxygen administration for patients with ARDS

Predicting recurrence of respiratory failure in critically ill patients with COVID-19: A preliminary study

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