COVID-19 and mechanical ventilation

Mechanical ventilation (MV) is used to treat patients with severe coronavirus disease 2019 (COVID-19). This severe respiratory illness, typically develops 8 days after symptom onset and when it does not respond to non‐invasive respiratory support, it requires advanced respiratory support, including high concentrations of inspired oxygen and mechanical ventilation. Such therapies are also required for the acute respiratory distress syndrome (ARDS), which has been widely studied over several decade. Obesity as a disease causes a restrictive lung disease and is a sufficient predisposing factor for difficult ventilation. Higher BMI patients are more likely to be young, with single organ failure, less chronic comorbidity but with increased severity of hypoxemia at presentation. Severe respiratory failure from coronavirus disease 2019 pneumonia not responding to non‐invasive respiratory support requires mechanical ventilation. Although ventilation can be a life‐saving therapy, it can cause further lung injury if airway pressure and flow and their timing are not tailored to the respiratory system mechanics of the individual patient. The phenomenon of “hard lung” is observed as the ventilation of the intubated patient is very arduous and recruitment requires a lot of effort. Coronavirus disease 2019-induced acute respiratory distress syndrome is more severe in morbidly obese patients. This relationship between BMI and mortality was investigated by several observational studies, but the relationship was not universally observed. Some studies found increased BMI was associated with an increased risk of requiring intubation and ventilation, but with no clear relationship with mortality. The combination is quite difficult as these patients oppose the ventilator. Our objective was to determine the association between MV for treatment of COVID-19.