Acute respiratory failure in COVID-19: is it "typical" ARDS?

• Published in: Critical care (London, England) Vol. 24; no. 1; p. 198
• Main Authors: Li, Xu, Ma, Xiaochun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06-05-2020; BioMed Central; BMC
• Subjects: Acute Lung Injury - diagnostic imaging; Acute Lung Injury - epidemiology; Acute Lung Injury - therapy; Acute respiratory distress syndrome; Adult respiratory distress syndrome; Berlin criteria; Betacoronavirus; Cardiac arrhythmia; China; Classification; Coronavirus; Coronavirus Infections - diagnosis; Coronavirus Infections - epidemiology; Coronavirus Infections - therapy; Coronaviruses; COVID-19; Creatine Kinase - blood; Critical care; Female; Germany; Health aspects; Humans; Intubation; L-Lactate Dehydrogenase - blood; Male; Mortality; Pandemics; Pneumonia, Viral - diagnosis; Pneumonia, Viral - epidemiology; Pneumonia, Viral - therapy; Radiography; Respiration, Artificial; Respiratory Distress Syndrome - classification; Respiratory Distress Syndrome - diagnostic imaging; Respiratory Distress Syndrome - epidemiology; Respiratory Distress Syndrome - therapy; Respiratory failure; Respiratory insufficiency; Respiratory system; Review; SARS-CoV-2; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Time Factors; United Kingdom; Ventilators; United Kingdom; China; Germany; Acute respiratory distress syndrome; COVID-19; Coronavirus; Berlin criteria
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-020-02911-9

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China. The World Health Organization (WHO) declared this outbreak a significant threat to international health. COVID-19 is highly infectious and can lead to fatal comorbidities especially acute respiratory distress syndrome (ARDS). Thus, fully understanding the characteristics of COVID-19-related ARDS is conducive to early identification and precise treatment. We aimed to describe the characteristics of COVID-19-related ARDS and to elucidate the differences from ARDS caused by other factors. COVID-19 mainly affected the respiratory system with minor damage to other organs. Injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS, and endothelial cells were less damaged with therefore less exudation. The clinical manifestations were relatively mild in some COVID-19 patients, which was inconsistent with the severity of laboratory and imaging findings. The onset time of COVID-19-related ARDS was 8-12 days, which was inconsistent with ARDS Berlin criteria, which defined a 1-week onset limit. Some of these patients might have a relatively normal lung compliance. The severity was redefined into three stages according to its specificity: mild, mild-moderate, and moderate-severe. HFNO can be safe in COVID-19-related ARDS patients, even in some moderate-severe patients. The more likely cause of death is severe respiratory failure. Thus, the timing of invasive mechanical ventilation is very important. The effects of corticosteroids in COVID-19-related ARDS patients were uncertain. We hope to help improve the prognosis of severe cases and reduce the mortality.