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In this commentary, the authors discuss an approach to hypoxemia management along with triage of resources. They focus on pathophysiologic mechanisms of disease in COVID-19, recognizing that there is likely heterogeneity in phenotypes.
Although the phenotyping is not validated, the authors provide a helpful strategy to consider treatment based upon physiologic phenotypes of hypoxemic respiratory failure in patients with COVID-19.
– Morgan Soffler, MD
This abstract is available on the publisher's site.
In the UK, more than 279 392 cases of COVID-19 had been documented by June 3, 2020, and more than 39 500 patients had died with the disease, according to the COVID-19 web-based dashboard at Johns Hopkins University.1 Data derived from the UK Intensive Care National Audit and Research Centre (ICNARC) Case Mix Programme Database show that, for the first 8062 patients admitted to the ICU across the UK with documented outcomes, by May 29, 2020, about 72% received advanced mechanical ventilation and the mortality rate was around 53%. This mortality far exceeds that of typical severe acute respiratory distress syndrome (ARDS).2 The significant surge in the number of patients requiring ventilatory support has presented the UK National Health Service with unprecedented challenges, including pressures on critical care capacity, resources, and supplies, concerns about staff protection, as well as ethical issues associated with triage and resource allocation.3 Debates about the way in which different modalities of ventilatory support should be provided to the largest number of patients, while controlling the number of critical care admissions and protecting staff, have at times generated adversarial positions at the extremes of the debate. The motivations behind these arguments are undoubtedly positive, but they do not necessarily help frontline clinicians who are caring for individuals with COVID-19.