Gene

Mechanical ventilation

Intensive care medicine

2019-20 coronavirus outbreak

Engineering

Biology

Pulmonary embolism

ARDS

Ventilation (architecture)

Betacoronavirus

Virology

Cardiology

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Outbreak

Environmental health

Coronavirus disease 2019 (COVID-19)

Hypoxemia

Mechanical engineering

Genetics

Population

Infectious disease (medical specialty)

Internal medicine

Respiratory system

Medicine

Respiratory physiology

Atelectasis

Disease

Lung

Phenotype

Pathology

Respiratory Physiology & Neurobiology

Coronavirus disease 2019 (COVID-19) can cause severe respiratory failure requiring mechanical ventilation. The abnormalities observed on chest computed tomography (CT) and the clinical presentation of COVID-19 patients are not always like those of typical acute respiratory distress syndrome (ARDS) and can change over time. This manuscript aimed to provide brief guidance for respiratory management of COVID-19 patients before, during, and after mechanical ventilation, based on the recent literature and on our direct experience with this population. We identify that chest CT patterns in COVID-19 may be divided into three main phenotypes: 1) multiple, focal, possibly overperfused ground-glass opacities; 2) inhomogeneously distributed atelectasis; and 3) a patchy, ARDS-like pattern. Each phenotype can benefit from different treatments and ventilator settings. Also, peripheral macro- and microemboli are common, and attention should be paid to the risk of pulmonary embolism. We suggest use of personalized mechanical ventilation strategies based on respiratory mechanics and chest CT patterns. Further research is warranted to confirm our hypothesis.

Distinct phenotypes require distinct respiratory management strategies in severe COVID-19