Does COVID-19 Require Different Ventilator Protocols?

As New York health officials race to secure ventilators, some physicians are starting to ask whether it’s time to change the way this equipment is used in patients with COVID-19.

Cameron Kyle-Sidell, MD, a critical care physician working in New York City, has been sounding the alarm on Twitter, urging healthcare professionals to consider that COVID-19 acts less like typical acute respiratory distress syndrome (ARDS) and more like high-altitude pulmonary edema (HAPE). The bottom line, Kyle-Sidell said, is that the current use of ventilators may be causing lung injury in COVID-19 patients and that it may be time to consider lung-protective strategies that utilize lower pressure settings.
Kyle-Sidell is not the only one raising questions about the use of the ARDS paradigm in COVID-19 patients. In a letter to the editor published in the American Journal of Respiratory and Critical Care Medicine on March 30, Luciano Gattinoni, MD, of the Medical University of Göttingen in Germany, and colleagues noted that COVID-19 patients in intensive care units in northern Italy had an atypical ARDS presentation, namely well-preserved lung gas volume and severe hypoxemia. Gattinoni and colleagues suggest in the letter that instead of high positive end-expiratory pressure (PEEP), physicians should consider the lowest possible PEEP and gentle ventilation.
https://www.medscape.com/viewarticle/928160