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What’s New in Intensive Care Medicine: Lessons from the COVID-19...
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What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Intensive Care".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 21103

Special Issue Editors

Dr. Roberto Rona

E-Mail Website
Guest Editor
Department of Emergency and Intensive Care, Ospedale San Gerardo, 20900 Monza, Italy
Interests: acute respiratory failure; SARS COVID-19; acute renal failure; CRRT; CAR-T cell therapy
Dr. Marco Giani

E-Mail Website
Guest Editor
School of Medicine and Surgery, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
Interests: ARDS; CRRT; ECMO
Special Issues, Collections and Topics in MDPI journals
Dr. Matteo Pozzi

E-Mail Website
Guest Editor
Department of Emergency and Intensive Care, Ospedale San Gerardo, 20900 Monza, Italy
Interests: ARDS; anticoagulation during ECMO; ICU-related long term outcome
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic had a sort of “booster” effect in our ICU clinical practice. The dramatic surge of ​​COVID-19 patients forced us to restructure our intensive care departments, including teams, spaces, and clinical organization.

From a clinical point of view, ICU physicians had to face new, original challenges. Due to the exposure risk, many routine procedures were burdened by an extraordinary gain of technical difficulties and safety issues. Moreover, many physicians (i.e., anesthesiologists, non-respiratory ICU physicians), had to face a disproportionate number of critically ill COVID-19 patients, which they were not accustomed to managing, both in terms of treatment and scale. These circumstances led to a diffuse risk of burnout in health-care workers.

We did learn a lot of lessons about many clinical issues: control of hyper-inflammatory state, ARDS ventilation, prone positioning, non-invasive respiratory support, extracorporeal oxygenation, and renal support.

The high patients’ number was also an important drive to implementing bedside monitoring devices and clinical procedures.

Social isolation during the COVID-19 outbreak ended in patients dying without their family. This pushed clinicians to further focus on patient centered outcomes and family engagement in ICU care. Follow-up programs after ICU discharge became crucial to better understand the long term physical, cognitive, and mental outcome together with patients and family quality of life.

A Special Issue dedicated to this “transition” could be very helpful for the Intensivist, to step forward from the COVID-19 pandemic to the next future in a more modern, personalized, and “human” ICU care.

Authors are invited to submit their results as original papers or short communications.  Reviews are also welcome.

Dr. Roberto Rona
Dr. Marco Giani
Dr. Matteo Pozzi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • COVID-19
  • intensive care unit
  • acute respiratory distress syndrome
  • extracorporeal membrane oxygenation
  • follow-up programs

Published Papers (9 papers)

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Editorial

Jump to: Research, Review

2 pages, 179 KiB  
Editorial
Lessons from the COVID-19 Pandemic
by Marco Giani, Matteo Pozzi and Roberto Rona
J. Clin. Med. 2023, 12(18), 5791; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm12185791 - 06 Sep 2023
Viewed by 553
Abstract
The COVID-19 pandemic was an unprecedented global crisis that significantly impacted around the world [...] Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)

Research

Jump to: Editorial, Review

11 pages, 1127 KiB  
Article
Post-Intensive Care Syndrome in Non-COVID-19 ICU Survivors during the COVID-19 Pandemic in South Korea: A Multicenter Prospective Cohort Study
by Jiyeon Kang, Jiwon Hong and Jin-Heon Jeong
J. Clin. Med. 2022, 11(22), 6653; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11226653 - 09 Nov 2022
Cited by 4 | Viewed by 1365
Abstract
A prospective observational cohort study investigated the prevalence of post-intensive care syndrome (PICS) among non-COVID-19 ICU survivors during the COVID-19 pandemic. Adults who had been admitted to the ICU for more than 24 h were enrolled, and followed-up at 3, 6, and 12 [...] Read more.
A prospective observational cohort study investigated the prevalence of post-intensive care syndrome (PICS) among non-COVID-19 ICU survivors during the COVID-19 pandemic. Adults who had been admitted to the ICU for more than 24 h were enrolled, and followed-up at 3, 6, and 12 months post-discharge. PICS (mental health, cognitive, and physical domains) was measured using the Hospital Anxiety and Depression Scale, Posttraumatic Diagnosis Scale, Montreal Cognitive Assessment, and Korean Activities of Daily Living (ADL) scale. Data were analyzed from 237 participants who completed all three follow-up surveys. The prevalence of PICS was 44.7%, 38.4%, and 47.3%, at 3, 6, and 12 months of discharge, respectively. The prevalence of PICS in the mental health and cognitive domains decreased at 6 and increased at 12 months. The prevalence of PICS in the physical domain declined over time. Changes in PICS scores other than ADL differed significantly according to whether participants completed follow-up before or after December 2020, when COVID-19 rapidly spread in South Korea. In the recent group, anxiety, depression, post-traumatic stress disorder, and cognition scores were significantly worse at 12 months than at 6 months post-discharge. The COVID-19 pandemic may have adversely affected the recovery of non-COVID-19 ICU survivors. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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9 pages, 707 KiB  
Article
A Cohort Study in Intensive Care Units: Health Decisions Related to Blood Transfusion during the COVID-19 Pandemic
by Raúl Juárez-Vela, José Antonio García-Erce, Vicente Gea-Caballero, Regina Ruiz de Viñaspre-Hernandez, José Ángel Santos-Sánchez, Juan Luis Sánchez-González, Eva María Andrés-Esteban, Michał Czapla, Clara Isabel Tejada, Kapil Laxman Nanwani-Nanwani, Ainhoa Serrano-Lázaro and Manuel Quintana-Díaz
J. Clin. Med. 2022, 11(15), 4396; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154396 - 28 Jul 2022
Cited by 1 | Viewed by 1446
Abstract
Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries [...] Read more.
Critically ill polytrauma patients with hemorrhage require a rapid assessment to initiate hemostatic resuscitation in the shortest possible time with the activation of a massive transfusion or a critical hemorrhage management protocol. The hospital reality experienced during the COVID-19 pandemic in all countries was critical, as it was in Spain; according to the data published daily by the Ministry of Health on its website, during the period of this study, the occupancy rate of intensive care units (ICUs) by patients diagnosed with the novel coronavirus disease (COVID-19) rose to 23.09% in Spain, even reaching 45.23% at the end of January 2021. We aimed to analyze the changes observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic period regarding the effectiveness of Spanish ICUs in terms of mortality reduction. We present a cross-sectional study that compares two cohorts of patients admitted to ICUs across all autonomous communities of Spain with a diagnosis of polytrauma. Results: Only age was slightly higher at admission during the first wave of the pandemic (47.74 ± 18.65 vs. 41.42 ± 18.82 years, p = 0.014). The transfusion rate during the pandemic increased by 10.4% compared to the previous stage (p = 0.058). Regarding hemostatic components, the use of tranexamic acid increased from 1.8% to 10.7% and fibrinogen concentrates from 0.9% to 1.9%. In the case of prothrombin complex concentrates, although there was a slight increase in their use, there were no significant differences during the pandemic compared to the previous period. Conclusion: Mortality showed no difference before and during the pandemic, despite the observed change in the transfusion policy. In summary, the immediate and global implementation of patient blood management (PBM) based on clinical transfusion algorithms should be mandatory in all hospitals in our country. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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14 pages, 1469 KiB  
Article
Development and Internal Validation of a New Prognostic Model Powered to Predict 28-Day All-Cause Mortality in ICU COVID-19 Patients—The COVID-SOFA Score
by Emanuel Moisa, Dan Corneci, Mihai Ionut Negutu, Cristina Raluca Filimon, Andreea Serbu, Mihai Popescu, Silvius Negoita and Ioana Marina Grintescu
J. Clin. Med. 2022, 11(14), 4160; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11144160 - 18 Jul 2022
Cited by 13 | Viewed by 2167
Abstract
Background: The sequential organ failure assessment (SOFA) score has poor discriminative ability for death in severely or critically ill patients with Coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission. Our aim was to create a new score powered to predict 28-day [...] Read more.
Background: The sequential organ failure assessment (SOFA) score has poor discriminative ability for death in severely or critically ill patients with Coronavirus disease 2019 (COVID-19) requiring intensive care unit (ICU) admission. Our aim was to create a new score powered to predict 28-day mortality. Methods: Retrospective, observational, bicentric cohort study including 425 patients with COVID-19 pneumonia, acute respiratory failure and SOFA score ≥ 2 requiring ICU admission for ≥72 h. Factors with independent predictive value for 28-day mortality were identified after stepwise Cox proportional hazards (PH) regression. Based on the regression coefficients, an equation was computed representing the COVID-SOFA score. Discriminative ability was tested using receiver operating characteristic (ROC) analysis, concordance statistics and precision-recall curves. This score was internally validated. Results: Median (Q1–Q3) age for the whole sample was 64 [55–72], with 290 (68.2%) of patients being male. The 28-day mortality was 54.58%. After stepwise Cox PH regression, age, neutrophil-to-lymphocyte ratio (NLR) and SOFA score remained in the final model. The following equation was computed: COVID-SOFA score = 10 × [0.037 × Age + 0.347 × ln(NLR) + 0.16 × SOFA]. Harrell’s C-index for the COVID-SOFA score was higher than the SOFA score alone for 28-day mortality (0.697 [95% CI; 0.662–0.731] versus 0.639 [95% CI: 0.605–0.672]). Subsequently, the prediction error rate was improved up to 16.06%. Area under the ROC (AUROC) was significantly higher for the COVID-SOFA score compared with the SOFA score for 28-day mortality: 0.796 [95% CI: 0.755–0.833] versus 0.699 [95% CI: 0.653–0.742, p < 0.001]. Better predictive value was observed with repeated measurement at 48 h after ICU admission. Conclusions: The COVID-SOFA score is better than the SOFA score alone for 28-day mortality prediction. Improvement in predictive value seen with measurements at 48 h after ICU admission suggests that the COVID-SOFA score can be used in a repetitive manner. External validation is required to support these results. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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11 pages, 887 KiB  
Article
Severe COVID-19 ARDS Treated by Bronchoalveolar Lavage with Diluted Exogenous Pulmonary Surfactant as Salvage Therapy: In Pursuit of the Holy Grail?
by Barbara Ruaro, Paola Confalonieri, Riccardo Pozzan, Stefano Tavano, Lucrezia Mondini, Elisa Baratella, Alessandra Pagnin, Selene Lerda, Pietro Geri, Marco Biolo, Marco Confalonieri and Francesco Salton
J. Clin. Med. 2022, 11(13), 3577; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133577 - 21 Jun 2022
Cited by 12 | Viewed by 2944
Abstract
Background: Severe pneumonia caused by coronavirus disease 2019 (COVID-19) is characterized by inflammatory lung injury, progressive parenchymal stiffening and consolidation, alveolar and airway collapse, altered vascular permeability, diffuse alveolar damage, and surfactant deficiency. COVID-19 causes both pneumonia and acute respiratory distress syndrome (COVID-19 [...] Read more.
Background: Severe pneumonia caused by coronavirus disease 2019 (COVID-19) is characterized by inflammatory lung injury, progressive parenchymal stiffening and consolidation, alveolar and airway collapse, altered vascular permeability, diffuse alveolar damage, and surfactant deficiency. COVID-19 causes both pneumonia and acute respiratory distress syndrome (COVID-19 ARDS). COVID-19 ARDS is characterized by severe refractory hypoxemia and high mortality. Despite extensive research, the treatment of COVID-19 ARDS is far from satisfactory. Some treatments are recommended for exhibiting some clinically positive impacts on COVID-19 patients although there are already several drugs in clinical trials, some of which are already demonstrating promising results in addressing COVID-19. Few studies have demonstrated beneficial effects in non-COVID-19 ARDS treatment of exogenous surfactant, and there is no evidence-based, proven method for the procedure of surfactant administration. Aim: The aim of this work is to underline the key role of ATII cells and reduced surfactant levels in COVID-19 ARDS and to emphasize the rational basis for exogenous surfactant therapy in COVID-19 ARDS, providing insights for future research. Methods: In this article, we describe and support via the literature the decision to administer large volumes of surfactant to two patients via bronchoalveolar lavage to maximize its distribution in the respiratory tract. Results: In this study, we report on two cases of COVID-19 ARDS in patients who have been successfully treated with diluted surfactants by bronchoalveolar lavage, followed by a low-dose bolus of surfactant. Conclusion: Combining the administration of diluted, exogenous pulmonary surfactant via bronchoalveolar lavage along with the standard therapy for SARS-CoV-2-induced ARDS may be a promising way of improving the management of ARDS. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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8 pages, 799 KiB  
Article
Cytokine Profiles as Potential Prognostic and Therapeutic Markers in SARS-CoV-2-Induced ARDS
by Francesco Salton, Paola Confalonieri, Giuseppina Campisciano, Rossella Cifaldi, Clara Rizzardi, Daniele Generali, Riccardo Pozzan, Stefano Tavano, Chiara Bozzi, Giulia Lapadula, Gianfranco Umberto Meduri, Marco Confalonieri, Manola Comar, Selene Lerda and Barbara Ruaro
J. Clin. Med. 2022, 11(11), 2951; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11112951 - 24 May 2022
Cited by 48 | Viewed by 2002
Abstract
Background. Glucocorticoids (GCs) have been shown to reduce mortality and the need for invasive mechanical ventilation (IMV) in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS). It has been suggested that serum cytokines levels are markers of disease severity in ARDS, although there is only [...] Read more.
Background. Glucocorticoids (GCs) have been shown to reduce mortality and the need for invasive mechanical ventilation (IMV) in SARS-CoV-2-induced acute respiratory distress syndrome (ARDS). It has been suggested that serum cytokines levels are markers of disease severity in ARDS, although there is only limited evidence of a relationship between the longitudinal cytokine profile and clinical outcomes in patients with SARS-CoV-2-induced ARDS treated with GC. Methods. We conducted a single-center observational study to investigate serial plasma cytokine levels in 17 patients supported with non-invasive ventilation (NIV) in order to compare the response in five patients who progressed to IMV versus 12 patients who continued with NIV alone. All patients received methylprednisolone 80 mg/day continuous infusion until clinical improvement. Results. The study groups were comparable at baseline. All patients survived. Although IL-6 was higher in the NIV group at baseline, several cytokines were significantly higher in the IMV group on day 7 (IL-6, IL-8, IL-9, G-CSF, IP-10, MCP-1, MIP-1α) and 14 (IL-6, IL-8, IL-17, G-CSF, MIP-1α, RANTES). No significant differences were observed between groups on day 28. Conclusions. Patients in the IMV group had higher inflammation levels at intubation than the NIV group, which may indicate a higher resistance to glucocorticoids. Higher GC doses or a longer treatment duration in these patients might have allowed for a better control of inflammation and a better outcome. Further studies are required to define the prognostic value of cytokine patterns, in terms of both GC treatment tailoring and timely initiation of IMV. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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9 pages, 431 KiB  
Article
Bedside Selection of Positive End Expiratory Pressure by Electrical Impedance Tomography in Patients Undergoing Veno-Venous Extracorporeal Membrane Oxygenation Support: A Comparison between COVID-19 ARDS and ARDS from Other Etiologies
by Michela Di Pierro, Marco Giani, Alfio Bronco, Francesca Maria Lembo, Roberto Rona, Giacomo Bellani and Giuseppe Foti
J. Clin. Med. 2022, 11(6), 1639; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061639 - 16 Mar 2022
Cited by 7 | Viewed by 1709
Abstract
Background: The interest in protective ventilation strategies and individualized approaches for patients with severe illness on veno venous extracorporeal support has increased in recent years. Wide heterogeneity exists among patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and ARDS from other etiologies [...] Read more.
Background: The interest in protective ventilation strategies and individualized approaches for patients with severe illness on veno venous extracorporeal support has increased in recent years. Wide heterogeneity exists among patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and ARDS from other etiologies (NC-ARDS). EIT is a useful tool for the accurate analysis of regional lung volume distribution and allows for a tailored ventilatory setting. The aim of this work is to retrospectively describe the results of EIT assessments performed in patients C-ARDS and NC-ARDS undergoing V-V ECMO support. Methods: A clinical EIT-guided decremental PEEP trail was conducted for all patients included in the study and mechanically ventilated. Results: 12 patients with C-ARDS and 12 patients with NC-ARDS were included in the study for a total of 13 and 18 EIT evaluations, respectively. No significant differences in arterial blood gas, respiratory parameters, and regional ventilation before and after the EIT exam were recorded. The subset of patients with NC-ARDS whose EIT exam led to PEEP modification was characterized by a lower baseline compliance compared with the C-ARDS group: 18 (16–28) vs. 27 (24–30) (p = 0.04). Overdistension significantly increased at higher steps only for the NC-ARDS group. A higher percentage of overdistension was described in patients with NC-ARDS when compared with patients with C-ARDS. Conclusions: EIT is feasible in patients with COVID-19-associated ARDS on veno-venous extracorporeal support and may help in tailoring the PEEP setting. Overall, severe COVID-19-related ARDS presents respiratory characteristics similar to severe “classical” NC-ARDS. However, C-ARDS is associated with a lower risk of overdistension at a higher PEEP level compared with NC-ARDS. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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13 pages, 1824 KiB  
Article
Impact of the Organizational Model Adopted during the COVID-19 Pandemic on the Perceived Safety of Intensive Care Unit Staff
by Elena Conoscenti, Maria Campanella, Antonino Sala, Maria Cristina Di Stefano, Dario Vinci, Rosario Lombardo, Giuseppe Arena, Angelo Ginestra, Rosario Fiolo, Fabio Tuzzolino, Alessia Ippolito, Gennaro Martucci, Giuseppe Enea and Angelo Luca
J. Clin. Med. 2022, 11(6), 1487; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061487 - 09 Mar 2022
Cited by 4 | Viewed by 1632
Abstract
Background: The SARS-CoV-2 pandemic had a devastating health, social, and economic effect on the population. Organizational, technical and structural operations aimed at protecting staff, outpatients and inpatients were implemented in an Italian hospital with a COVID-19 dedicated intensive care unit. The impact of [...] Read more.
Background: The SARS-CoV-2 pandemic had a devastating health, social, and economic effect on the population. Organizational, technical and structural operations aimed at protecting staff, outpatients and inpatients were implemented in an Italian hospital with a COVID-19 dedicated intensive care unit. The impact of the organizational model adopted on the perceived safety among staff was evaluated. Methods: Descriptive, structured and voluntary, anonymous, non-funded, self-administered cross-sectional surveys on the impact of the organizational model adopted during COVID-19 on the perceived safety among staff. Results: Response rate to the survey was 67.4% (153 completed surveys). A total of 91 (59%) of respondents had more than three years of ICU experience, while 16 (10%) were employed for less than one year. Group stratification according to profession: 74 nurses (48%); 12 medical-doctors (7%); 11 physiotherapists (7%); 35 nurses-aides (22%); 5 radiology-technicians (3%); 3 housekeeping (1%); 13 other (8%). The organizational model implemented at ISMETT made them feel safe during their workday. A total of 113 (84%) agreed or strongly agreed with the sense of security resulting from the implemented measures. A vast majority of respondents perceived COVID-19 as a dangerous and deadly disease (94%) not only for themselves but even more as vectors towards their families (79%). A total of 55% of staff took isolation measures and moved away from their home by changing personal habits. The organizational model was perceived overall as appropriate (91%) to guarantee their health. Conclusion: The vast majority of respondents perceived the overall model applied during an unexpected, emergency situation as appropriate. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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Review

Jump to: Editorial, Research

21 pages, 5327 KiB  
Review
Different Methods to Improve the Monitoring of Noninvasive Respiratory Support of Patients with Severe Pneumonia/ARDS Due to COVID-19: An Update
by Paolo Pelosi, Roberto Tonelli, Chiara Torregiani, Elisa Baratella, Marco Confalonieri, Denise Battaglini, Alessandro Marchioni, Paola Confalonieri, Enrico Clini, Francesco Salton and Barbara Ruaro
J. Clin. Med. 2022, 11(6), 1704; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061704 - 19 Mar 2022
Cited by 53 | Viewed by 6374
Abstract
The latest guidelines for the hospital care of patients affected by coronavirus disease 2019 (COVID-19)-related acute respiratory failure have moved towards the widely accepted use of noninvasive respiratory support (NIRS) as opposed to early intubation at the pandemic onset. The establishment of severe [...] Read more.
The latest guidelines for the hospital care of patients affected by coronavirus disease 2019 (COVID-19)-related acute respiratory failure have moved towards the widely accepted use of noninvasive respiratory support (NIRS) as opposed to early intubation at the pandemic onset. The establishment of severe COVID-19 pneumonia goes through different pathophysiological phases that partially resemble typical acute respiratory distress syndrome (ARDS) and have been categorized into different clinical–radiological phenotypes. These can variably benefit on the application of external positive end-expiratory pressure (PEEP) during noninvasive mechanical ventilation, mainly due to variable levels of lung recruitment ability and lung compliance during different phases of the disease. A growing body of evidence suggests that intense respiratory effort producing excessive negative pleural pressure swings (Ppl) plays a critical role in the onset and progression of lung and diaphragm damage in patients treated with noninvasive respiratory support. Routine respiratory monitoring is mandatory to avoid the nasty continuation of NIRS in patients who are at higher risk for respiratory deterioration and could benefit from early initiation of invasive mechanical ventilation instead. Here we propose different monitoring methods both in the clinical and experimental settings adapted for this purpose, although further research is required to allow their extensive application in clinical practice. We reviewed the needs and available tools for clinical–physiological monitoring that aims at optimizing the ventilatory management of patients affected by acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Full article
(This article belongs to the Special Issue What’s New in Intensive Care Medicine: Lessons from the COVID-19 Pandemic)
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