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. 2020 May 11;279:103455. doi: 10.1016/j.resp.2020.103455

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© 2020 Elsevier B.V. All rights reserved.

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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Fig. 1 — Summary of the key points for respiratory management of COVID-19 patients according to the three distinct phenotypes.

Phenotype 1: good compliance, but severe hypoxemia. PEEP should be set with the aim to redistribute pulmonary flow and reduce shunting. In this case, using the principles generally applied in ARDS, and thus setting the PEEP according to the best driving pressure, will probably lead to use of lower PEEP (as the compliance is good), resulting in less oxygenation. iNO could be considered in these cases, and prone positioning can redistribute perfusion, but is generally not very useful at this stage.

Phenotype 2: atelectasis and derecruitment are predominant. In this case, high PEEP and prone positioning can recruit non-aerated areas of the lung. Recruitment maneuvers (RMs) may play a role in these cases, whereas iNO is less useful.

Phenotype 3: typical CT pattern of moderate-to-severe ARDS, with alveolar edema and low compliance. Respiratory settings should follow the general principles applied for ARDS. PEEP should be set according to the best driving pressure; eventually, RMs, prone positioning, and ECMO may be considered.