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Minerva Cardioangiologica 2020 Oct 15

DOI: 10.23736/S0026-4725.20.05356-6

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Early versus late tracheal intubation in COVID-19 patients: a pro-con debate also considering heart-lung interactions

Luca CABRINI 1, 2, Luca GHISLANZONI 1, 2, Paolo SEVERGNINI 1, 2, Giovanni LANDONI 3, 4 , Martina BAIARDO REDAELLI 3, Federico FRANCHI 5, Stefano ROMAGNOLI 6, 7

1 Università degli Studi dell'Insubria, Varese, Italy; 2 Ospedale di Circolo e Fondazione Macchi, Varese, Italy; 3 Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 4 Vita-Salute San Raffaele University, Milan, Italy; 5 Department of Medicine, Surgery and Neuroscience, Anesthesiology and Intensive Care, University Hospital of Siena, Siena, Italy; 6 Section of Anesthesiology, Health Sciences Department, Intensive Care and Pain Medicine, University of Florence, Florence, Italy; 7 Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy


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The best timing of orotracheal intubation and invasive ventilation in COVID-19 patients with acute respiratory distress syndrome is unknown. The use of non-invasive ventilation, a life-saving technique in many medical conditions, is debated in patients with ARDS since prolonged NIV and delayed intubation may be harmful. Shortage of intensive care beds and ventilators during a respiratory pandemic can trigger a widespread use of early non-invasive ventilation in many hospitals but which is the best way to ventilate patients with severe bilateral pneumonia and severely increased spontaneous ventilation is controversial. Moreover, viral spreading to health-care workers and other hospitalized patients is an issue for any device used to administer oxygen. Even if protective mechanical ventilation is currently the gold standard for the management of acute respiratory distress syndrome, tracheal intubation is not without risks and is associated with delirium, hemodynamic instability, immobilization and post intensive care syndrome. Both invasive and non-invasive ventilation are associated with advantages and limitations that should be carefully considered when patients with COVID-19-ARDS need our attention. In the absence of strong evidence , in this review we highlight all the pro and con of these two different approaches.


KEY WORDS: Coronavirus disease 2019; Acute respiratory failure; Non invasive ventilation; Early; Delayed invasive ventilation; Intensive care; Critical care; Anesthesia

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