ESAIC Academy

Summary:  Third ESA COVID-19 Webinar on Respiratory Support in COVID-19 Patients
Dr. Hans-Christian Zaun, Ph.D.
Scientific Advisor, MULTILEARNING GROUP.

This third webinar on COVID-19 was hosted by Prof. Dr. Ilona Bobek, of the Department of Anaesthesiology and Intensive Care Medicine, Budapest, Hungary, with support from Scientific Faculty Leader, Prof. Dr. Marcelo Gama de Abreu of the Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Dresden, Germany. The primary purpose of this seminar was to discuss the unique situation of providing respiratory support for COVID-19 patients.

The webinar began with Prof. Dr. Luciano Gatinoni of the University of Göttingen, Germany, who emphasized that COVID-19 does not lead to a typical acute respiratory distress syndrome (ARDS). COVID-19 is an atypical vessel/endothelial disease that requires different respiratory treatments depending on the clinical manifestations. He asserted the importance of monitoring patients to reduce lung injury. 

The second section of the webinar involved Prof. Dr. Christian Putensen of the University Hospital Bonn, Germany, and Prof. Dr. Giuseppe Fonti from Milan, Italy, who discussed the role of non-invasive respiratory support and intubation. 

Dr. Putensen began by addressing the disadvantages of assisted breathing and the possible mechanisms that may lead to ventilatory induced lung injury. Furthermore, he discussed the issue of pleural pressure swings resulting from ventilator support, which may be reduced with the addition of CPAP. CPAP is well-tolerated and continuous when compared to high-flow oxygen. Dr. Putensen continued by discussing when to use intubation and invasive mechanical ventilation.

Dr. Fonti continued the section on non-invasive ventilation and emphasized that non-invasive ventilation may result in lung damage in ARDS COVID-19 patients. He went on to discuss the benefits of the Helmet CPAC for COVID-19 patients as well as improvements obtaining by placing patients in a prone position during the procedure as opposed to the supine position.

The webinar returned to Dr. Putensen to discussed adjunctive therapies for COVID-19 patients, particularly those patients displaying type ‘H’ phenotypes. These included the use of the prone position, inhaled nitrous oxide as a transient therapy, as well as the issue of hypercoagulation that is frequently detected in patients.

The final section of the webinar was by Prof. Dr. Paolo Pelosi of Genoa, Italy. Dr. Pelosi’s topic was the weaning and extubation for recovering COVID-19 patients. He emphasized that COVID-19 is a disease that attacks both the lungs and the vasculature. To this end, Dr. Pelosi discussed the importance that hospital personnel develop clear local guidelines for extubation.  Furthermore, he added that respiratory physiotherapy with proper follow up will be crucial for recovering COVID-19 patients.

When asked to give a take-home message, all the speakers agreed that avoiding excessive ventilation and monitoring is crucial. Furthermore, If intubation is required, it is best to initiate early.

This webinar will enable caregivers of patients with COVID-19 to

• Identify when invasive ventilation should be initiated
• Recognise the different disease phenotypes and their own needs
• Define the most appropriate respiratory support for individual patients

Practical skills to be acquired after attending this Webinar
The user can:

• Anticipate failure of non-invasive ventilation
• Choose appropriate invasive mechanical ventilation settings
• Define which adjunctive therapies should be used

Affective skills acquired after attending to this Webinar
The user is aware of:

• Having a systematic approach enables one to better handle stressful situations
• Synergy with other specialties improves the efficiency of care
• Despite the lack of evidence based medicine in this particular disease, one can still handle safely based on expert opinion