High tidal volume to unload the respiratory muscles in COVID-19

What is it about?

Hypoxemia is well tolerated for a period of time. In high mountains 60% saturation and 30 mmHg of pO2 are tolerated. Dyspnoe however is not tolerable and ventilatory failure causes organ failure and death. So unloading the ventilatory muscles and relief of dyspnea by high volume mechanical ventilation does relieve such complaints even if severe hypoxemia persists. Such strategy results in high survival rate (100% in our limited study) and keeps the patient in good condition without the negative effects of invasive ventilation.

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Why is it important?

Mortality of prone positioning, high PEEP, low tidal volume and deep sedation is high between 30 and 50% and much higher in COVID-19 with more than 50and up to. 88%. Patients ventilated with high tidal volumes, no PEEP, passive ventilation without any own breathing efforts have low mortality, good quality of life and do not need any sedatives. Stephen Hawkins is a well lnown example. We could show in intubated patients that a switch from high PEyeP, low volume, deep sedation to high volume, no PEEP an passive hyperventilation, as used by the latter group, rapidly improved their condition and all survived.

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