Abstract:

The SARS-Cov-2 insults lung epithelial cells and causes inflammatory cell infiltration initially. The secondary injury of endothelial cells induces microvascular leakage which aggravates pulmonary edema. The clinical manifestations of COVID-19 pneumonia include hypoxemia, dyspnea, and subsequent pulmonary hypertension and acute core pulmonale in severe cases. The ejection of left ventricle is comprised by enlarged right ventricle which could induce the low cardiac output and shock. These progresses can be revised by improving oxygenation with mechanical ventilation. However, improper mechanical ventilation will induce lung injury and deteriorate the acute cor pulmonale. Thus, the ideal approach of mechanic ventilation should be based on cardiopulmonary protection. Patients should receive extracorporeal membrane oxygenation (ECMO) if no response to protective mechanical ventilation to decrease the organ injury. Here we recommend a flowchart for mechanic ventilation based on cardiopulmonary protection.

Key words: COVID-19, Mechanic ventilation, Lung protection