Initial Emergency Department Mechanical Ventilation Strategies for COVID-19 Hypoxemic Respiratory Failure and Ards

Introduction Severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 is an emerging viral pathogen that causes the novel coronavirus disease of 2019 COVID-19 and may result in hypoxemic respiratory failure necessitating invasive mechanical ventilation in the most severe cases. Objective This narrative review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation. Discussion In severe cases, COVID-19 leads to hypoxemic respiratory failure that may meet criteria for acute respiratory distress syndrome ARDS. The mainstay of treatment for ARDS includes a lung protective ventilation strategy with low tidal volumes 48 mLkg predicted body weight, adequate positive end-expiratory pressure PEEP, and maintaining a plateau pressure of 30 cm H2O. While further COVID-19 specific studies are needed, current management should focus on supportive care, preventing further lung injury from mechanical ventilation, and treating the underlying cause. Conclusions This review provides evidence-based recommendations for the treatment of COVID-19 related respiratory failure requiring invasive mechanical ventilation.