In #COVID19, coagulopathy causes widespread pulmonary thrombosis that compromise the lung’s normal vasoconstrictive response to hypoxia, creating ventilation-perfusion (V/Q) mismatch and profound hypoxemia.
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Vigorous patient efforts to breathe can increase lung injury. Clinical approaches include:
A. Targeted nonvigorous breathing
B. Awake prone positioning
C. Supplemental O2
D. NIV (CPAP, BiPAP, HFNC)
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Progressive deterioration on higher FiO2 or noninvasive ventilation may warrant early intubation, sedation, and/or paralysis, and ventilation with lower PEEP (8-10 cm H2O)
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