Distinct phenotypes require distinct respiratory management strategies in severe COVID-19

Chiara Robba, Denise Battaglini, Lorenzo Ball, Nicolo’ Patroniti, Maurizio Loconte, Iole Brunetti, Antonio Vena, Daniele Roberto Giacobbe, Matteo Bassetti, Patricia Rieken Macedo Rocco, Paolo Pelosi

Research output: Contribution to journalReview articlepeer-review


Coronavirus disease 2019 (COVID-19) can cause severe respiratory failure requiring mechanical ventilation. The abnormalities observed on chest computed tomography (CT) and the clinical presentation of COVID-19 patients are not always like those of typical acute respiratory distress syndrome (ARDS) and can change over time. This manuscript aimed to provide brief guidance for respiratory management of COVID-19 patients before, during, and after mechanical ventilation, based on the recent literature and on our direct experience with this population. We identify that chest CT patterns in COVID-19 may be divided into three main phenotypes: 1) multiple, focal, possibly overperfused ground-glass opacities; 2) inhomogeneously distributed atelectasis; and 3) a patchy, ARDS-like pattern. Each phenotype can benefit from different treatments and ventilator settings. Also, peripheral macro- and microemboli are common, and attention should be paid to the risk of pulmonary embolism. We suggest use of personalized mechanical ventilation strategies based on respiratory mechanics and chest CT patterns. Further research is warranted to confirm our hypothesis.

Original languageEnglish
Article number103455
JournalRespiratory Physiology and Neurobiology
Publication statusPublished - Aug 2020


  • COVID-19
  • Mechanical ventilation
  • Non-Invasive ventilation
  • Positive end expiratory pressure
  • Prone position
  • SARS-CoV-2

ASJC Scopus subject areas

  • Neuroscience(all)
  • Physiology
  • Pulmonary and Respiratory Medicine


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