Early vs late intubation in COVID19? Is there any diffrent line of approach in manging ARDS in covid

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There are reports that Patients on ventilator have high mortality Probably ventilation induced lung injury is contributing to mortality Therefore, there is a school of thought, which advocate non invasive ventilation for COVID 19 associated with Hypoxia, which according to them has better outcome Non invasive ventilation has its own advantages, patient using his own Muscules for breathing, therefore diaphragmatic injury and respiratory muscle disuse atrophy is reduced

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Intubation or NIV is really controversial School of thought is suggesting intubation is not helpful at all rather adding to lung injury Other school of thought is better NIV in PRONE position They say basically it is not pneumonitis but cytokine storm responsible for ARDS myocardial injury is additional factor They consider more of thrombotic effect causing DIC

Thanx dr Ashok Leel
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vigorous spontaneous inspiratory efforts can rapidly lead to patient self-induced lung injury. In Delaying intubation,the risk of lung injury increases and therefore intubation should be performed as soon as possible. So timing is important.

Timing is important Vigorous effort of breathing I turn induce lung injury Early intubation decrease the chance and amount of lung injury So early intubation is advised for better out come

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Timing is all important in COVID Infection like other things in life. Ventilator induces forced lung injury. All has their pros and cons. Intubation should be performed at earliest.

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An alternative to invasive ventilation- which should be initial option of patient of COVID-19 with moderate to severe symptoms is A Prone position high flow nasal canulla oxygenation which is a non- invasive mode of ventilation. It is potentially non - aerosolisation method than mechanical ventilation. Patient uses his own accessory muscles of breathing. But it is crystal clear that if 1- 2 hours,of HFNO does not improve the oxygenation saturation and respiratory effort - immediate early intubation will be life saving . So Non - imvasive ventilation should only be tried very experts in ICU care are able and should clearly know that when to intubate . When such facilities are not available- early intubation ia always preferred before serious lung injury occurs

Hypoxia bin covid 19 pt should be treated by noninvasive method like Bipap because intubated pt has high mortality and sedation is required for intubation after sedation effect bis over pt try to remove intubated tube so intubated pt should always be keep on continuous sedation which is also dangerous so intubation is the last step in covid pt

This study looks at advanced airway management in critically ill or injured patients treated by physician manned emergency medical services, comparing early (on-scene) intubation to late (emergency department) intubation.