Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review. (September 2021)

• Record Type: Journal Article
• Authors: Battaglini, Denise; Robba, Chiara; Ball, Lorenzo; Silva, Pedro L.; Cruz, Fernanda F.; Pelosi, Paolo; Rocco, Patricia R.M.
• Is Part Of: British journal of anaesthesia. Volume 127:Number 3(2021)
• Page Start: 353
• Page End: 364
• Publication Date: 2021-09
• Subjects: ARDS -- COVID-19 -- high-flow nasal oxygen therapy -- lung injury -- noninvasive ventialtion -- P-SILI -- SARS-CoV-2 -- spontaneous breathing; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2021.05.024
• Languages: English
• ISSNs: 0007-0912

Abstract

Summary: COVID-19 pneumonia is associated with hypoxaemic respiratory failure, ranging from mild to severe. Because of the worldwide shortage of ICU beds, a relatively high number of patients with respiratory failure are receiving prolonged noninvasive respiratory support, even when their clinical status would have required invasive mechanical ventilation. There are few experimental and clinical data reporting that vigorous breathing effort during spontaneous ventilation can worsen lung injury and cause a phenomenon that has been termed patient self-inflicted lung injury (P-SILI). The aim of this narrative review is to provide an overview of P-SILI pathophysiology and the role of noninvasive respiratory support in COVID-19 pneumonia. Respiratory mechanics, vascular compromise, viscoelastic properties, lung inhomogeneity, work of breathing, and oesophageal pressure swings are discussed. The concept of P-SILI has been widely investigated in recent years, but controversies persist regarding its mechanisms. To minimise the risk of P-SILI, intensivists should better understand its underlying pathophysiology to optimise the type of noninvasive respiratory support provided to patients with COVID-19 pneumonia, and decide on the optimal timing of intubation for these patients.