b'With Video Series, USU Breathes Life Into Ventilator Training for COVID-19by pneumonia, sepsis, trauma, inhala-tionoflung-damagingsubstancesor near-drowning. As it progresses, fluid accumulatesinthealveoli,blocking oxygen from reaching the bloodstream. Some patients will develop scarring in the lungs or fibrosis; others may suffer pneumothorax or collapsed lung.Formanypatientssufferingfrom ARDS,mechanicalventilationisan essential, lifesaving treatment. But venti-lation can be a double-edged sword: The pressure required to keep the lungs open and the blood oxygenated can sometimes cause catastrophic, even fatal, damage toArmy Col. Jessica Bunin, MD, explains the basics of airway pressure release ventilation, an option for the lungs delicate tissues.mechanical ventilation that is helpful as an oxygen-salvage therapy for patients with acute respiratory Strikingtherightbalancehasbeendistress syndrome. Image from a health.mil video.challengingwithCOVID-19-related ARDS, also known as CARDS. Earlythe lungs. Thats turned up some nota- Thisearlyflexibilityexplains reportsindicatedthatmorepatientsbledifferencesbetweenCARDSandwhysomehypoxemicandspontane-withpneumoniacausedbythenoveltraditional ARDS. ouslybreathingpatientsappearquite coronavirusrequiredintensivecare,Unlike routinely encountered casescomfortabledespitehighventilation more in intensive care needed mechani- of ARDS, respiratory system compli- requirements, Marini said. cal ventilation, and more on ventilatorsance[inCARDS]remainsrelativelyOther physicians have dubbed these died than in other kinds of ARDS. Innormaldespiteimpressivehypox- paradoxicalpatientshappyhypox-fact, some studies indicate that mortal- emia,indicatingflexible,gas-filledics, as they continue to hold conver-ity from CARDS is double that seen inlungs until later and/or more advancedsation and appear otherwise healthy traditional ARDS. 1stages,accordingtoarecentedito- priortoexaminationdespitehav-The higher mortality rate associatedrial in Critical Care Medicine by Johningdangerouslylowoxygenlevels. withCARDShaspromptedacloserJ.Marini,MD,oftheUniversityofSome have compared the presentation look at the impact COVID-19 has onMinnesota, in St. Paul. 2 of these patients in early CARDS to individualswithhigh-altitudepul-monary edema (HAPE), although the conclusionsdrawnfromthatcom-So far, we have had considerable successparisondifferbetweenprominent with APRV in our COVID patients. This haspulmonologists. allowed us to support and extubate severald iFFerenTa pproachesLuciano Gattinoni, MD, of the depart-patients successfully, while avoiding paralysis,ment of Anesthesiology and Intensive CareattheMedicalUniversityof proning, deep sedation, inhaled pulmonaryGttingen, Germany, classified patients withsimultaneoushypoxemiaand vasodilators, or ECMO. compliant lungs as having the Type L phenotypeofCOVID-19pneumonia- Josh Farkas, MD induced ARDS. Thistypeofrespira-tory failure also has low ventilation to 522020 COMPENDIUM OF FEDERAL MEDICINE'