Progressive respiratory failure in COVID-19: a hypothesis

The coronavirus disease 2019 (COVID-19) pandemic is a challenge for intensive care units (ICUs) worldwide because of the large numbers of patients, a scarcity of resources, the poor prognosis of patients they treat, and uncertainty regarding the disease's pathogenesis. The presence of oedema is illustrated by ground-glass opacities of the lung parenchyma on lung CT.2 If patients require mechanical ventilation, oxygenation improves following prone positioning, higher PEEP, and restrictive fluid management. Based on our early findings in our first 90 patients with COVID-19, we now include D-dimer and IL-6 in our routine laboratory tests in patients with COVID-19, and increase the prophylactic dose of low-molecular-weight heparin(nadroparin 5700 IU subcutaneously, from once a day to twice a day).4 In addition, we do a lung CT even at a low level of suspicion of pulmonary embolism, and we encourage others to do the same.