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.

2019 年冠状病毒病 (COVID-19) 可导致严重呼吸衰竭，需要机械通气。胸部计算机断层扫描 (CT) 观察到的异常和 COVID-19 患者的临床表现并不总是像典型的急性呼吸窘迫综合征 (ARDS) 那样，并且可能会随着时间的推移而发生变化。本手稿旨在根据最近的文献和我们对该人群的直接经验，为机械通气之前、期间和之后的 COVID-19 患者呼吸管理提供简要指导。我们发现，COVID-19 的胸部 CT 模式可分为三种主要表型：1）多发性、局灶性、可能过度灌注的毛玻璃样混浊；2）不均匀分布的肺不张；3) 不完整的、类似 ARDS 的模式。每种表型都可以受益于不同的治疗和呼吸机设置。另外，外周大栓塞和微栓塞也很常见，应注意肺栓塞的风险。我们建议使用基于呼吸力学和胸部 CT 模式的个性化机械通气策略。需要进一步的研究来证实我们的假设。