Antiporda, Alexandra Victoria I.

BSN 4-Y1-2
NCMB 418

Reflection Essay: Initial emergency department mechanical ventilation strategies for COVID-19
hypoxemic respiratory failure and ARDS

The COVID-19 pandemic has caused severe respiratory illnesses worldwide, putting hospitals and
healthcare systems under immense strain. Patients with viral pneumonia, acute respiratory failure, or acute
respiratory distress syndrome (ARDS) may require hospitalization. ARF is characterized by poor
oxygenation, pulmonary infiltrates, and a sharp onset. The article explores the physiology of COVID-19-
related ARDS, lung protective ventilation methods, customized mechanical ventilation strategies,
additional treatments, and the best mechanical ventilation strategy for emergency doctors.

The paper offers a narrative summary of invasive mechanical ventilation techniques for COVID-
19-related respiratory failure. The authors evaluated case studies, series, retrospective studies, narrative
reviews, systematic reviews, meta-analyses, and other research techniques. As the infection day goes on, it
is crucial to continuously check patients for the onset of ARDS. Supportive care, which includes oxygen
therapy for hypoxemic patients, is the main treatment method for COVID-19 patients. The breathing
support approach is crucial in the management of COVID-19 ARDS, just like it is for conventional ARDS
brought on by other infections. The first step is to achieve SpO2 > 92% by utilizing nasal cannulas to supply
oxygen. Second, there is debate about the use of high flow nasal oxygen, which is greatly influenced by the
treatment location. The second goal is to avoid noninvasive ventilation. Finally, take into account
extracorporeal membrane oxygenation for rescue and prone ventilation for treatment. Due to worries about
viral transmission to other patients and medical personnel, the use of high flow nasal oxygen and non-
invasive ventilation for COVID-19 ARDS is largely dependent on the healthcare environment. The
National COVID-19 Clinical Evidence Taskforce states that while it strongly advises against the use of
high flow nasal oxygen in emergency rooms, it does so for negative pressure single rooms. Negative
pressure rooms can use non-invasive ventilation if the proper virus transmission safeguards are taken. The
advantages of non-invasive ventilation have been inconsistently demonstrated in clinical practice, and
issues with aerosol formation and an elevated risk of virus transmission have been brought up. Prone
ventilation seems to be effective for COVID-19 ARDS. ARDS patients have been positioned prone for
further therapy to improve oxygenation and results. This position, also referred to as "proning," uses
gravitational forces to reduce the gradient of pleural pressure between dependent and non-dependent areas
and to conform the shape of the lung to the chest cavity. Localized vasodilation and improved ventilation-
perfusion matching are the results of inhaled pulmonary vasodilators, which largely diffuse to ventilated
alveoli. Although no mortality benefit has been established, nitric oxide and prostacyclins (such
epoprostenol) are used as emergency medications to reduce hypoxia-mediated vasoconstriction and
Antiporda, Alexandra Victoria I.
BSN 4-Y1-2
NCMB 418

improve oxygenation in severe ARDS. These decisions must be taken in the context of the local area of
practice, taking the type and accessibility of ventilator circuits into account. Additionally, corticosteroids,
a very contentious medicine, are crucial in both the early and late stages of ARDS. Contrary to the Surviving
Sepsis Campaign recommendations, the NIH guidelines, which are based on scant evidence, do not
advocate the treatment of corticosteroids in critically sick patients with COVID-19-induced ARDS. They
advise waiting until the patient is in septic shock before administering systemic corticosteroids to COVID-
19 patients without ARDS because recent systematic evaluations indicated only minor decreases in
mortality and a quicker cure of septic shock. For COVID-19 patients who fit the criteria for ARDS, steroids
should be considered in cooperation with the admitting critical care team.

The COVID-19 pandemic has significantly impacted individuals worldwide, with vaccine escape
mutants posing a threat to immune system development. Several companies have developed COVID-19
vaccines in clinical trials, with some showing over 90% potency. In critical cases, ARDS criteria may be
met by maintaining an equilibrium pressure of less than 30 cm H2O and implementing lung protective
ventilation strategies. Adjunctive therapy, such as corticosteroids, NMBAs, pulmonary vasodilators, and
ECMO, should be considered individually with input from the critical care team. Developing specialized
medicines is urgently necessary to treat COVID-19 and its impacts.

Mechanical breathing is necessary in various clinical and physiological situations, but nurses face
challenges in managing patients who are mechanically ventilated. The patient's admission and justification
for mechanical ventilation impact their assessment and care. In the ICU, fundamental, team-based,
evidence-based nursing management principles are followed, including patient safety, comfort, hygiene,
stress management, and pain and sedation management. However, intensive care nurses face various
difficulties with mechanically ventilated patients. A full awareness of technology concerns and a patient-
centered approach is necessary for effective management and nursing care. Mechanical ventilation can be
a necessary therapeutic intervention, but it also presents potential challenges. Evidence-based nursing care
is crucial for high-quality health outcomes for mechanically ventilated patients.