Conclusionĭuring the recovery period of ARDS among mechanically-ventilated COVID-19 patients, attention should be paid to the monitoring of physiological dead space and metabolism. We found that remarkably decreased ventilatory efficiency (e.g., the ratio of dead space to tidal volume 70–80%, arterial to end-tidal CO 2 difference 18–23 mmHg and ventilatory ratio 3–4) and hypermetabolism (oxygen consumption 300–400 ml/min, CO 2 elimination 200–300 ml/min) may explain why these patients experienced more severe respiratory distress and CO 2 retention in the late phase of ARDS caused by COVID-19. To explain these pathophysiological features and discuss the ventilatory strategy during the late phase of severe ARDS in COVID-19 patients, we first used a metabolic module on a General Electric R860 ventilator (Engstrom Carestation GE Healthcare, USA) to monitor parameters related to gas metabolism, lung mechanics and physiological dead space in two COVID-19 patients. However, the underlying mechanics remain unclear. Actually, we newly observed that some mechanically ventilated COVID-19 patients recovering from severe ARDS (more than 14 days after invasive ventilation) often experienced evidently gradual increases in CO 2 retention and minute ventilation.
Recently, several articles have mentioned that the early acute respiratory distress syndrome (ARDS) caused by COVID-19 significantly differ from those of ARDS due to other causes. An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally.
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