Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3305
Peer-review started: April 22, 2020
First decision: May 1, 2020
Revised: May 15, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: August 6, 2020
Processing time: 106 Days and 5 Hours
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.
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.
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.
Core tip: An effective and practical weaning protocol is of the utmost importance to coronavirus disease 2019 (COVID-19) patients with respiratory failure requiring mechanical ventilation. Here, we present two patients with critical COVID-19. Such patients can achieve good outcomes following a sequential weaning protocol that is attentive to the timing of intubation and extubation, early prone positioning, infection control, and sequential advancement and withdrawal of invasive ventilation.