A review by our researchers has looked at the optimal approach to ventilation in COVID-19 patients.

The researchers from Guy’s and St Thomas’ and King’s College London looked at how to improve the safety of mechanical ventilation in COVID-19 patients in intensive care units. They found that the ventilation must provide the patient with enough oxygen to survive, but air pressures must be based on the characteristics of the patient’s lungs. This avoids excessive stretching and prevents further injuries to the lungs.

The research was published in The Physiological Society’s journal Experimental Physiology.

COVID-19 can lead to inflammation in the lung, which may require mechanical ventilation in the most severe cases. While mechanical ventilation is not a cure for COVID-19, it may be necessary to keep patients alive in the acute phase of the disease, allowing the patient to make a recovery.

The study was a critical analysis of the literature on mechanical ventilation in COVID-19 patients, providing a way to improve this technique by tailoring it to the patients’ lungs. In addition, the work was informed by the research team’s experience in caring for COVID-19 patients in ICU at Guy’s and St Thomas’. The team used mechanical ventilation and extracorporeal membrane oxygenation (ECMO), achieving the highest survival rates in the UK.

The authors said: “We are excited that our analysis proposes new criteria for the management of mechanical ventilation for COVID-19 patients in the intensive care unit. These criteria have not been studied in a clinical trial yet; their potential effectiveness is expected based on the evidence available at the time of this research and a strong physiological rationale.

“In other words, our study provides the basis for clinical trials where the settings of mechanical ventilation can be tailored to the individual patient level, based on their respiratory system mechanics and function. If successful, these trials could provide the basis for new approaches to mechanical ventilation in COVID-19 patients, which may be applied more widely to other patients with acute respiratory failure.”

Federico Formenti’s work was supported by a Medical Research Council Confidence in Concept grant and by an NIHR i4i grant together with Luigi Camporota.