Authors of an editorial in JAMA Internal Medicine review the evidence for the management of patients with the acute respiratory distress syndrome (ARDS) that may apply to patients with severe COVID-19, what has been learned about treatment of these patients, and the gaps in knowledge that remain.
As Bos, et al. (2020) observe, "Critically ill patients with severe COVID-19 frequently meet the criteria for ARDS, including bilateral radiographic opacities and a sufficient degree of hypoxemia (partial pressure of arterial oxygen to fraction of inspired oxygen ≤300 mm Hg). Although there are no specific pharmacologic therapies for ARDS, decades of rigorous clinical trials have established that meticulous supportive care with the foundation of lung-protective ventilation improves ARDS outcomes. Lung protective ventilation can be defined as a low-volume, low-pressure ventilation strategy. Standardized protocols can help to ensure high-quality care, particularly during a crisis when less experienced physicians may be caring for critically ill patients. In addition to supportive care and lung protective ventilation, treatment of patients with ARDS typically includes symptom-targeted sedation and analgesia, consideration of neuromuscular blockade for ventilator dyssynchrony or severe hypoxemia, prone positioning for moderate to severe ARDS, and consideration of extracorporeal membrane oxygenation for patients with very severe ARDS. At present, most reports suggest that the respiratory physiology of ARDS both associated and not associated with COVID-19 are similar, thus reinforcing the importance of adhering to evidence-based management principles that have proven effective for ARDS management."
Reference: Bos LDJ, et al. Severe COVID-19 Infections—Knowledge Gained and Remaining Questions. JAMA Intern Med. Published online Sept. 18, 2020. doi:10.1001/jamainternmed.2020.6047