The lastest updated surviving sepsis guidelines for COVID-19 patient recommends a high-peep strategy in the intubated, mechanically ventilated patient. As most of these patients present with moderate to severe ARDS, PEEP is used to keep lung areas open and therefor to improve oxygenation. This seems to be especially true in the classical case of ARDS, where the lung become 'wet' and 'heavy' which results in widespread atelectasis of the dependent parts of the lungs, often further complicated by pleural effusions. Classical CT appearance in the acute phase of ARDS is an opacification with an antero-posterior density gradient. Dense consolidation in the most dependent regions merges into a background of widespread ground-glass attenuation and the normal or hyperexpanded lung in the non-dependent areas (Howling SJ et al. Clin Radiol 1998;53(2):105-109). The theory behind these changes is that the increased weight of overlying lung causes compression-atelectasis posteriorly. The fact that prone positioning these patients quickly redistributes these gradients supports this theory (Desai SR et al. Anaesthesiology 1991;74(1):15-23). Chest CT's in patients with COVID-19 often show ground-glass opacification with or without consolidations. These are changes often seen in viral pneumonia. Several case series suggest, that CT abnormalities seem to be mostly bilateral and tend to have a peripheral distribution, often involving the lower lobes. In contrast to the classical ARDS pleural thickening, pleural effusion and lymphadenopathy seem to be a less common finding (Shi H et al. Lancet Infect Dis 2020). The leading problem in COVID-19 patients with ARDS is hypoxemia, while hypercapnia does not seem to be a significant problem. Sometimes profound hypoxemia does not seem to correlate with patient symptoms at all. In regards to the images above, atelectasis might not be the predominant reason for V/Q mismatches in these patients. Observations of mechanically ventilated patients in our unit and other hospitals in Switzerland have shown, that higher PEEP levels (15cmH2O and higher) often result in significantly reduced compliance values complicating ventilation and favouring the development of pulmonary over-inflation. This observation might support the theory that patients with COVID do not represent the traditional manner of ARDS with distinctive atelectasis. Another observation that supports this theory is that COVID-19 patients often do not respond as clearly to Prone Positioning as classical ARDS patients do. More probably, V/Q mismatch seems so happen on a more microscopical level in COVID-Patients. Lung compliance is often normal on these patients and, therefore, applying high PEEP-levels does NOT add any benefit at all. Maybe the principle of less is more also applies to COVID-19 patients we treat (Gattinoni L et al. Intensive Care Medicine; 46, pages780–782(2020)) Looking at the New Surviving Sepsis Campain COVID-19 Guidelines: Given these considerations, the strategy with High PEEP-levels in general should be questioned in principle.
Errol Muller
31/5/2020 01:33:25
I was suffering from herpes virus 6 years, i was totally depressed due to my predicament , until i meet Dr Ajayi the great Traditional healer who cured me, he also have cure to other disease you are facing. you can also contact him now on whatsapp +2348154724883.or via email: ajayiherbalhome@gmail.com for more information and get your healing..
Errol Muller
31/5/2020 01:34:02
I was suffering from herpes virus 6 years, i was totally depressed due to my predicament , until i meet Dr Ajayi the great Traditional healer who cured me, he also have cure to other disease you are facing. you can also contact him now on whatsapp +2348154724883.or via email: ajayiherbalhome@gmail.com for more information and get your healing..
Lynne Wilson
8/6/2020 10:28:59
Irrespective of receiving daily oral or future injectable depot therapies, these require health care visits for medication and monitoring of safety and response. If patients are treated early enough, before a lot of immune system damage has occurred, life expectancy is close to normal, as long as they remain on successful treatment. However, when patients stop therapy, virus rebounds to high levels in most patients, sometimes associated with severe illness because i have gone through this and even an increased risk of death. The aim of “cure”is ongoing but i still do believe my government made millions of ARV drugs instead of finding a cure. for ongoing therapy and monitoring. ARV alone cannot cure HIV as among the cells that are infected are very long-living CD4 memory cells and possibly other cells that act as long-term reservoirs. HIV can hide in these cells without being detected by the body’s immune system. Therefore even when ART completely blocks subsequent rounds of infection of cells, reservoirs that have been infected before therapy initiation persist and from these reservoirs HIV rebounds if therapy is stopped. “Cure” could either mean an eradication cure, which means to completely rid the body of reservoir virus or a functional HIV cure, where HIV may remain in reservoir cells but rebound to high levels is prevented after therapy interruption.Dr Afrid Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
clara james
22/6/2020 18:25:19
NATURAL HERBS AND VEGANS CURE FOR Herpes 1&2 THAT WORK FAST WITHIN 14 DAYS WITH DR ELINFOH HERBAL MEDICINE, I saw so many testimonies about Dr ELINFOH a great HERBAL DOCTOR that will help you CURE and give you the rightful health to live a joyful life, i didn't believe it at first, but as the pain got worsen and my life was at risk after using lots of ARV drugs from the hospital and no changes so i decided to give a try to Dr Elinfoh I contacted him also and told him i want a cure for Herpes , he gave me advice on what i must do and he deliver it to me in my home address i gave him and i got the medicine which i use according to his instruction, and today i must say I am so grateful to this man Dr Elinfoh for curing me from Herpes and for restoring me back to my normal health and a sound life and i am making this known to every one out there who have been trying all day to be cured from Herpes or any sickness should not waste more time just contact him with his details below, believe me this is the only way to get cured from Hepres , this is the real solution we all have been searching for. Do not waste more time contacting him today for you can also leave a sound and happy life. contact info below. Email: (drelinfohherbalhome@gmail.com ) or WhatsApp or Call him on: +2348110492072. and you can as well contact him on other issues you are having like*HEPATITIS B*DIABETICS*CANCER*ALS*HERPES*BODY REDUCTION*BREAST ENLARGEMENT*FIBROD*CANCER*PREGNANCY MISCARRIAGE*Relationship issues etc.. ** Neoplasms*Cardiovascular Disease (CVD)
clara james
22/6/2020 18:42:15
NATURAL HERBS AND VEGANS CURE FOR Herpes 1&2 THAT WORK FAST WITHIN 14 DAYS WITH DR ELINFOH HERBAL MEDICINE, I saw so many testimonies about Dr ELINFOH a great HERBAL DOCTOR that will help you CURE and give you the rightful health to live a joyful life, i didn't believe it at first, but as the pain got worsen and my life was at risk after using lots of ARV drugs from the hospital and no changes so i decided to give a try to Dr Elinfoh I contacted him also and told him i want a cure for Herpes , he gave me advice on what i must do and he deliver it to me in my home address i gave him and i got the medicine which i use according to his instruction, and today i must say I am so grateful to this man Dr Elinfoh for curing me from Herpes and for restoring me back to my normal health and a sound life and i am making this known to every one out there who have been trying all day to be cured from Herpes or any sickness should not waste more time just contact him with his details below, believe me this is the only way to get cured from Hepres , this is the real solution we all have been searching for. Do not waste more time contacting him today for you can also leave a sound and happy life. contact info below. Email: (drelinfohherbalhome@gmail.com ) or WhatsApp or Call him on: +2348110492072. and you can as well contact him on other issues you are having like*HEPATITIS B*DIABETICS*CANCER*ALS*HERPES*BODY REDUCTION*BREAST ENLARGEMENT*FIBROD*CANCER*PREGNANCY MISCARRIAGE*Relationship issues etc.. ** Neoplasms*Cardiovascular Disease (CVD)
lisa
24/6/2020 15:43:06
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Huan Wang
28/6/2020 03:45:43
Irrespective of receiving daily oral or future injectable depot therapies, these require health care visits for medication and monitoring of safety and response. If patients are treated early enough, before a lot of immune system damage has occurred, life expectancy is close to normal, as long as they remain on successful treatment. However, when patients stop therapy, virus rebounds to high levels in most patients, sometimes associated with severe illness because i have gone through this and even an increased risk of death. The aim of “cure”is ongoing but i still do believe my government made millions of ARV drugs instead of finding a cure. for ongoing therapy and monitoring. ARV alone cannot cure HIV as among the cells that are infected are very long-living CD4 memory cells and possibly other cells that act as long-term reservoirs. HIV can hide in these cells without being detected by the body’s immune system. Therefore even when ART completely blocks subsequent rounds of infection of cells, reservoirs that have been infected before therapy initiation persist and from these reservoirs HIV rebounds if therapy is stopped. “Cure” could either mean an eradication cure, which means to completely rid the body of reservoir virus or a functional HIV cure, where HIV may remain in reservoir cells but rebound to high levels is prevented after therapy interruption. @dr.uganloga Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone ToxicitySyndrome Fibrodysplasia Ossificans Progressiva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpes,Inflammatory bowel disease ,Copd,Diabetes,Hepatitis,I read about him online how he cure Tasha and Tara so i contacted him on druganlogaherbalhome@gmail.com even talked on whatsapps +2348107181623 believe me it was easy i drank his herbal medicine for two weeks and i was cured just like that isn't @dr.uganloga a wonder man? Yes he is! I thank him so much so i will advise if you are suffering from one of those diseases please do contact him he's a nice man. Comments are closed.
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