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June 4, 2020

Alternatives to Invasive Ventilation in the COVID-19 Pandemic

Author Affiliations
  • 1Pritzker School of Medicine, Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
JAMA. 2020;324(1):43-44. doi:10.1001/jama.2020.9611

Since its invention in the 1940s, the positive pressure ventilator has always been known to have both risks and benefits. Although mechanical ventilation is unquestionably lifesaving, there are numerous associated drawbacks. Beyond the obvious and immediate limitations that patients require translaryngeal intubation and are physically attached to a ventilator, delivery of gas by positive pressure also creates mechanical stress and causes strain on lung tissue. This stress can lead to ventilator-induced lung injury, compounding the underlying lung condition that precipitated the initial respiratory failure.1 Despite advances in knowledge about protective ventilation strategies to limit ventilator-induced lung injury (most notably use of low tidal volumes), concern remains for this iatrogenic injury in all patients undergoing intubation and mechanical ventilation.