Diagnostic, prognostic and therapeutic strategies in critically ill COVID–19 patients

This thesis is a collection of investigations focusing on classification and prognostication, and strategies to improve oxygenation in patients with COVID-19.
In Chapter 2 we report the results of an observational study including 109 critically ill COVID-19 patients and suggest that an adjusted definition Berlin definition, in which PEEP is replaced by a minimum level of air flow in patients under HFNO results in comparable groups. Chapter 3 contains the results of an international multicenter observational study in 139 COVID-19 ARDS patients. We concluded that the baseline RALE score has no prognostic value, but that an increase of the RALE score does.
In Chapter 4 we report the results of a multicenter observational study in 82 COVID-19 ARDS patients. We concluded that the CTSS was associated with mortality, while the RALE score did not. In Chapter 5 we present the findings of an observational study in 28 COVID-19 ARDS patients with a lung CT scan at low and high PEEP. We concluded that these frequently have collapsed lung tissue that can be reaerated.
Chapter 6 shows the results of an analysis in 933 COVID-19 ARDS patients that were categorized as having received higher or lower PEEP. We concluded that higher PEEP does not confer clinical benefit in invasively ventilated COVID-19 ARDS patients.
In Chapter 7 of the 734 COVID-19 ARDS patients, 438 patients received early prone positioning. We concluded that there was no difference in mortality at day 28.
In Chapter 8 we describe the rational of the ‘Practice of Adjunctive Treatments in Intensive Care Unit Patients with Coronavirus Disease 2019’ (PRoAcT-COVID) study.
In Chapter 9 we investigated the practice of awake prone positioning in 946 patients. We concluded that awake prone positioning was used in one in every six patients.