Respiratory characteristics and related intraoperative ventilatory management for patients with COVID-19 pneumonia
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SPECIAL FEATURE: SPECIAL ARTICLE Anesthesia in the Time of COVID-19
Respiratory characteristics and related intraoperative ventilatory management for patients with COVID‑19 pneumonia Hiroko Aoyama1 · Kanji Uchida1 Received: 7 August 2020 / Accepted: 14 August 2020 © The Author(s) 2020
Abstract A substantial proportion of patients with coronavirus disease 19 (COVID-19) develop severe respiratory failure. Although the exact pathophysiology of severe COVID-19 pneumonia remains unknown and the characteristics of these patients are heterogeneous, the acute respiratory failure often fulfills criteria for acute respiratory distress syndrome (ARDS) and the clinical characteristics are also consistent with what is previously known about ARDS. Cohort studies also report distinctively high association between perioperative COVID-19 and postoperative mortality. In this special article, we review several publications on the pathophysiology of COVID-19, and discuss intraoperative ventilatory management for patients with COVID-19 based on the respiratory characteristics of COVID-19 pneumonia in light of the ongoing controversy of clinical phenotypes. Keywords SARS-CoV-2 · COVID-19 · Respiratory characteristics · Intraoperative management · Phenotype
Introduction The current COVID-19 pandemic has caused unprecedented economic burden and stress on both global healthcare systems and in-hospital management of patients infected with severe acute respiratory syndrome coronavirus 2 (SARSCoV-2). To date we have experienced tremendous advances in our understanding of COVID-19. However, there remains much to be learned about how SARS-CoV-2 affects the lungs to cause lasting lung injury and about how we should approach treatment of these patients. There is currently no treatment specifically approved for COVID-19. Refractory hypoxia due to COVID-19 pneumonia is the primary cause of death among COVID-19 associated patients [1, 2] though relatively little is known about respiratory characteristics of COVID-19 pneumonia. Furthermore, for anesthesiologists who take care of patients undergoing surgery with possible COVID-19 infection, the association between intraoperative anesthetic management, including respiratory management,
* Kanji Uchida uchidak‑[email protected]‑tokyo.ac.jp 1
Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo, 7‑3‑1, Hongo, Bunkyo‑ku, Tokyo 113‑8655, Japan
and postoperative outcomes is a key question that remains unclear. The goal of the current review is to describe postoperative outcomes for patients who were perioperatively confirmed with COVID-19 and to further the discussion related to respiratory characteristics of COVID-19 pneumonia. We also propose intraoperative ventilation strategies for anesthesia care-providers who treat patients scheduled for surgery under possible COVID-19 infection.
COVID‑19 associated postoperative outcomes The relevant literature on intraoperative ventilatory management in COVID-19 patients is scarce. A case–control cohort that evaluated postoperative out
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