Dr. Laurent Brochard, St. Michael’s Hospital, Toronto, ON

Patients with acute respiratory failure related to COVID-19 often present the criteria for ARDS. They however may differ on a number of characteristics, which may modify the management of ventilation. Those specific features include the possible dissociation between the extent of lung injury on the X-ray or as measured by compliance and the degree of hypoxemia, the presence of silent hypoxemia in some patients and an abnormal lung vasculature (observed at autopsy), which may explain shunt not responding to positive pressure. Individualization of therapy is essential. Management with high-flow nasal therapy before intubation is an interesting approach but needs adequate protection. The decision for intubation may be difficult in case of pure hypoxemia and different techniques may help to improve oxygenation.

Learning Objectives
At the end of this presentation, attendees will be able to:

  • Describe the specific aspects of COVID-19 related to respiratory physiology;
  • Explore the pros and cons of non-invasive techniques versus intubation; and
  • Explain how to individualize mechanical ventilation.