COVID-19: positive experience with differentiated tactics of mechanical ventilation of the lungs for different phenotypes (L-phenotype).

Relevance: Studies have previously been published on a possible differential approach to respiratory therapy in patients with COVID-19 depending on the L- or H-phenotype.The authors believe that early tracheal intubation reduces the risk of lung injury. The use of deep sedation and low PEEP (6-8 cmH₂O) and early intubation may prevent transition to type H.

Method and results: Eleven patients with COVID-19 type L pneumonia received respiratory support based on the proposed guidelines. Eight women and three men (ages 45 to 84) with COVID-19 type L pneumonia were treated in the intensive care unit. Did they all receive oxygen therapy up to 15 L/min. high-flow oxygen therapy up to 60 L/ min, non-invasive ventilation of the lungs. If it was impossible to reduce FiO₂ from 100 to 75% within 2-3 h or if the patient was intolerant to NIV, early tracheal intubation was used.The minute ventilation volume was set to maintain CO₂ <60 mmHg. and pH>7.25 in venous blood. Sedation was performed by intravenous titration of fentanyl and propofol. If deeper sedation was required to synchronize the patient to the ventilator, intravenous muscle relaxants were used over 24-48 hours (bolus or intravenous titration) instead of sedation.

Conclusion: All 11 patients were successfully weaned from the mechanical ventilation of the lungs. A differentiated approach to respiratory therapy for COVID-19 L-type pneumonia proved to be an effective approach in these patients.It is probably worth avoiding deep sedation of patients on mechanical ventilation with L-type pneumonia, which would reduce the time spent on mechanical ventilation and reduce the risk of mortality from nosocomial bacterial infection.The new MVL strategy for L-type pneumonia and the problem of deep sedation require more research. But the available data suggests that it probably has benefits.