Respiratory failure is the most worrisome problem of COVID-19. Patients may develop severe pneumonia requiring invasive mechanical ventilation and a significant proportion of them dies. It has been suggested that brainstem might play a role in severe respiratory failure of COVID-19 patients. We described three COVID-19 patients in ICU at Federico II Hospital in Naples that, although had recovered from pneumonia, could not be weaned from invasive mechanical ventilation. Our clinical evaluation was consistent with an involvement of the brainstem and especially of respiratory centre thus possibly explaining the weaning failure in patients that were awake and had recovered from lung involvement. Our data, though limited, indicate that brainstem involvement may play a role in respiratory failure and perhaps in the high death rate of COVID-19 patients. Moreover, the weaning failure from mechanical ventilation due to central respiratory drive depression might underlie the unusual long stay in ICU reported for COVID-19 patients.

呼吸衰竭是 COVID-19 最令人担忧的问题。患者可能会发展为需要有创机械通气的严重肺炎，其中很大一部分会死亡。有人提出脑干可能在 COVID-19 患者的严重呼吸衰竭中起作用。我们在那不勒斯 Federico II 医院的 ICU 中描述了三名 COVID-19 患者，尽管他们已经从肺炎中康复，但无法从有创机械通气中脱机。我们的临床评估与脑干特别是呼吸中枢受累一致，因此可能解释了清醒并从肺部受累中恢复的患者的脱机失败。我们的数据虽然有限，但表明脑干受累可能与呼吸衰竭有关，也可能与 COVID-19 患者的高死亡率有关。