Mechanical Ventilation Therapy on Covid-19

Abstract

—Covid 19 patient in critical condition characterized by Acute Respiratory Distress Syndrome (ARDS) for which the mainstay of treatment is represented by mechanical ventilation, sepsis and septic shock that require immediate treatment to save his life. This Paper is a literature review of mechanical ventilation therapy on Covid 19 through the search of textbook and accredited journal sites. Currently the pulmonary manifestations of Covid-19 are described as a spectrum with 2 points. The starting point is infection Covid-19 type L which responds to oxygen therapy conventional and requiring Covid-19 type H infection oxygen therapy with higher pressure. As initial therapy, give oxygen with a nasal cannula or face mask, if it is not responding use High Flow Nasal Canule (HFNC). Non-Invasive Ventilation (NIV) is considered if there are no signs of immediate need for intubation but must be accompanied by close monitoring with a target SpO2 of not more than 96%. Immediately intubate and give mechanical ventilation if this occurs deterioration during use of HFNC or NIV or not improving within 1 hour. Ventilation mode may use volume or pressure based with the recommended Tidal Volume range is 4-8 ml / kgbw. Use end-expiratory positive pressure (PEEP) limit height in type H while in type L limit with a maximum PEEP of 8-10 cmH2O. The breathing rate is regulated by calculation adequate minute ventilation with a plateau pressure (Pplat) <30 cmH2O. If refractory hypoxemia occurs, have pulmonary recruitment, and consider extracorporeal membrane oxygenation (ECMO) therapy. Mechanical ventilation therapy requires initiation, steps, and appropriate ventilator settings according to the severity of Covid-19.