Table 2 Research priorities in COVID-19-related acute respiratory failure
Pathophysiology | Exploration of “personalised” respiratory interventions based on phenotypes (using clinical, physiological, biological or radiological criteria) |
Awake self-proning | Optimal technique (such as complete prone or side to side), timing and duration Impact on escalation of respiratory support, tracheal intubation and mortality Effect of combination with HFNO or NIV on outcome measures |
HFNO | Risk of aerosolisation, optimal setting, monitoring and prediction of failure Comparison with NIV/CPAP and weaning strategies Use in moderate-to-severe hypoxemia (PaO2/FiO2 less than 200 mm Hg) Impact on outcomes (ICU/hospital length of stay and mortality) |
NIV (including CPAP) | Risk of aerosolisation, monitoring, helmet versus other interfaces Multimodal strategies with HFNO Impact on escalation of respiratory support, outcomes (ICU/hospital length of stay and mortality) Impact of NIV in subset of patients with mixed respiratory failure, cardiogenic pulmonary oedema and COVID-19-related ARDS |
Corticosteroids | Effect of timing of initiation, different types, dose, optimal duration, tapering schedule Impact of laboratory biomarkers on timing, dose and duration of corticosteroid Interaction of corticosteroids with other COVID-19 therapeutics such as Remdesivir, Baricitinib, etc |
Invasive mechanical ventilation | Initiation of invasive mechanical ventilation: Optimal timing, triggers and technique with respect to patient and HCW safety Impact of non-conventional ventilation strategies based on respiratory mechanics on outcomes (ICU/hospital length of stay and mortality) Sedation and NMBA: Optimal sedation strategy and monitoring techniques. Timing, duration, technique (continuous versus bolus) and monitoring of NMBA PEEP: Strategy for personalisation and method of selection Fluid management: Restrictive versus liberal. Impact on ARDS phenotypes Assessing fluid responsiveness Weaning and liberation: Optimal timing and strategy. Impact of HFNO or NIV post-extubation. Predictive measures for failure ECMO: Optimal timing and patient selection. Resource planning in the constraints of a pandemic |
Tracheostomy | Optimal timing, strategy for HCWs safety and post-procedure care. Direct effect of SARS-CoV-2 virus on larynx and trachea |
Infection control | Strategy for HCWs safety during aerosol generating procedures in resource limited settings Role of different types of PPE and strategies to optimize their use De-escalation of isolation precautions: time and/or testing based Impact of different interventional strategies on the reduction in aerosolisation Efficacy and safety of tele-ICU or remote monitoring to limit exposure |