A proposed lung ultrasound and phenotypic algorithm for the care of COVID-19 patients with acute respiratory failure
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SPECIAL ARTICLE
A proposed lung ultrasound and phenotypic algorithm for the care of COVID-19 patients with acute respiratory failure Proposition d’un algorithme base´ sur l’e´chographie pulmonaire et le phe´notype physiologique pour la prise en charge des patients atteints de la COVID-19 souffrant d’insuffisance respiratoire aigue¨ Andre´ Y. Denault, MD, PhD, FRCPC, FASE, FCCSm, ABIM-CCM • Ste´phane Delisle, PhD, RRT, FCCM • David Canty, MBBS, MD, PhD, FANZCA • Alistair Royse, MBBS, MD, FRACS, FCSANZ • Colin Royse, MBBS, MD, ´ tienne J. Couture, MD, FRCPC • Martin Girard, MD, FANZCA • Ximena Cid Serra, MD • Caroline E. Gebhard, MD • E FRCPC • Yiorgos Alexandros Cavayas, MD, MSc, FRCPC • Nicolas Peschanski, MD, PhD • Ste´phan Langevin, MD, FRCPC • Paul Ouellet, PhD, RRT, FCCM Received: 21 April 2020 / Revised: 30 April 2020 / Accepted: 4 May 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Pulmonary complications are the most common clinical manifestations of coronavirus disease (COVID19). From recent clinical observation, two phenotypes have emerged: a low elastance or L-type and a high elastance or H-type. Clinical presentation, pathophysiology, pulmonary mechanics, radiological and ultrasound findings of these two phenotypes are different. Consequently, the
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01704-6) contains supplementary material, which is available to authorized users.
therapeutic approach also varies between the two. We propose a management algorithm that combines the respiratory rate and oxygenation index with bedside lung ultrasound examination and monitoring that could help determine earlier the requirement for intubation and other surveillance of COVID-19 patients with respiratory failure. Re´sume´ Les complications pulmonaires du coronavirus (COVID-19) constituent ses manifestations cliniques les plus fre´quentes. De re´centes observations cliniques ont fait e´merger deux phe´notypes : le phe´notype a` e´lastance faible
A. Y. Denault, MD, PhD, FRCPC, FASE, FCCSm, ABIMCCM (&) Division of Critical Care, Centre Hospitalier de l’Universite´ Montre´al, Montreal, QC, Canada e-mail: [email protected]
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Universite´ de Montre´al, 5000 Belanger Street, Montreal, QC, Canada H1T 1C8
Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, Australia
S. Delisle, PhD, RRT, FCCM De´partement de me´decine de famille et me´decine d’urgence, Universite´ de Montre´al, Montreal, QC, Canada
Department of Medicine, Monash University, Melbourne, Australia
A. Royse, MBBS, MD, FRACS Department of Surgery, University of Melbourne, Melbourne, Australia
Colle`ge Ellis, Trois-Rivie`res, QC, Canada
Cardiothoracic Surgeon, Royal Melbourne Hospital, Melbourne, Australia
D. Canty, MBBS, MD, PhD, FANZCA Department of Surgery, University of Melbo
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