Current recommendations for respiratory support and mechanical ventilation in COVID-19 patients based on recent literature and published guidelines.

• Patients with mechanically-assisted ventilation could develop ventilator-associated-pneumonia (VAP)

• Patients with VAP could have a significantly longer ICU and hospital length of stay

• The treatment of VAP may account for almost half of all antibiotics administered in ICUs

NIV is often possible before intubation is required. This helps avoid the potential complications of invasive ventilation, which can reduce the length of stay, and may decrease mortality in the ICU.

• Patients could develop ventilator-associated lung injury (VALI)

• VALI could turn into acute lung injury (ALI) or acute respiratory distress syndrome (ARDS)

• Multiple organ failure and mortality rate may increase, associated with ALI or ARDS

If intubation is necessary the first aim may be to improve gas exchange and lung mechanics. The initiation of a lung protective ventilation strategy and the optimization of ventilator settings may be key elements during this phase. The ventilator has to adapt to the patient and not vice versa.

• The incidence of acute lung injuries (ALI) or acute respiratory distress syndrome (ARDS) could delay the start of the weaning process

• The delayed induction of weaning may lead to weaning failure

• Early detection of risk factors may contribute to successful weaning and shorten ICU length of stay

Mechanical ventilation should only take as long as necessary. Otherwise the risk of complications and lung damage increases as well as the ICU length of stay. The crucial factors for successful weaning and extubation are an interdisciplinary strategy and an accurate assessment of the patient.

• Patients could develop acute respiratory failure after extubation and could require reintubation

• Mortality rate could increase with extubation failure

• Extubation failure can be associated with prolonged patient care and significantly increased costs

The prevention of reintubation and the rapid recovery of the patient is of the greatest importance. A ventilator designed to facilitate free spontaneous breathing throughout the respiratory pathway, may facilitate early mobilization of the patient.