Spontaneous Breathing and Evolving Phenotypes of Lung Damage in Patients with COVID-19: Review of Current Evidence and Forecast of a New Scenario

• Main Authors: Roberto Tonelli, Alessandro Marchioni, Luca Tabbì, Riccardo Fantini, Stefano Busani, Ivana Castaniere, Dario Andrisani, Filippo Gozzi, Giulia Bruzzi, Linda Manicardi, Jacopo Demurtas, Alessandro Andreani, Gaia Francesca Cappiello, Anna Valeria Samarelli, Enrico Clini
• Format: Article
• Language: English
• Published: MDPI AG 2021-03-01
• Series: Journal of Clinical Medicine
• Subjects: SARS-CoV-2; COVID-19; mechanical ventilation; spontaneous breathing; acute respiratory distress syndrome; acute respiratory failure
• Online Access: https://www.mdpi.com/2077-0383/10/5/975

The mechanisms of acute respiratory failure other than inflammation and complicating the SARS-CoV-2 infection are still far from being fully understood, thus challenging the management of COVID-19 patients in the critical care setting. In this unforeseen scenario, the role of an individual’s excessive spontaneous breathing may acquire critical importance, being one potential and important driver of lung injury and disease progression. The consequences of this acute lung damage may impair lung structure, forecasting the model of a fragile respiratory system. This perspective article aims to analyze the progression of injured lung phenotypes across the SARS-CoV-2 induced respiratory failure, pointing out the role of spontaneous breathing and also tackling the specific respiratory/ventilatory strategy required by the fragile lung type.