Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study

Status of the Respiratory Therapy Profession in Ghana: A Cross-Sectional Study

INTRODUCTION AND PURPOSE

The respiratory therapy (RT) profession in Ghana is a new and emerging field. Therefore, the purpose of this study was to assess and evaluate the RT profession as a needs assessment to help policymakers and key stakeholders shape the profession in Ghana.

METHODS

We conducted a cross-sectional study approved by the Institutional Review Board at Loma Linda University. Participants included RTs, RT students, faculty, physicians, nurses, and midwives, who were recruited via email, WhatsApp, and snowball sampling. Data were collected through an anonymous survey consisting of demographic, professional, and attitudinal questions. We analyzed the data using descriptive statistics and inferential tests, employing IBM Corp. Released 2023. IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp.

RESULTS

A total of 195 participants were involved in the study from Ghana, with 83 men (42.6%) and 112 women (57.4%), with an average age of 32.33 (SD ± 8.83) years. A majority (56.4%) held bachelor's degrees, with nurses (35.9%) and physicians (21.9%) forming the largest professional groups. The survey found that 64.2% of participants acknowledged a high demand for RTs, yet interaction with RTs was limited due to their limited availability in the region. Notably, 86.8% were familiar with nebulizers, and 80.6% with Ambu bags. The study also highlighted significant challenges in the profession, including overwhelming workloads (64.3%), lack of recognition (100%), and resource shortages. Asthma emerged as the top respiratory condition treated by RTs. The Net Promoter Score for the respiratory therapy profession, at 26.92, demonstrates a moderately positive response, suggesting an increasing need for enhanced interest among professionals in the field of respiratory therapy in Ghana.

CONCLUSION

To our knowledge, this was the first needs assessment study that evaluated the field of the RT profession in Ghana. The findings indicate robust support for the necessity, development, and expansion of the RT field in the country. Future prospective studies are recommended to further evaluate the impact and effectiveness of the RT profession on patient care outcomes.

Glucocorticoid therapy for acute respiratory distress syndrome: Current concepts

Acute respiratory distress syndrome (ARDS), a fatal critical disease, is induced by various insults. ARDS represents a major global public health burden, and the management of ARDS continues to challenge healthcare systems globally, especially during the pandemic of the coronavirus disease 2019 (COVID-19). There remains no confirmed specific pharmacotherapy for ARDS, despite advances in understanding its pathophysiology. Debate continues about the potential role of glucocorticoids (GCs) as a promising ARDS clinical therapy. Questions regarding GC agent, dose, and duration in patients with ARDS need to be answered, because of substantial variations in GC administration regimens across studies. ARDS heterogeneity likely affects the therapeutic actions of exogenous GCs. This review includes progress in determining the GC mechanisms of action and clinical applications in ARDS, especially during the COVID-19 pandemic.

Non-invasive positive pressure ventilation can reduce perioperative mortality in acute aortic dissection patients with hypoxemia

Background

Hypoxemia is a common critical respiratory complication in patients with acute aortic dissection (AAD) before operation and results in adverse outcomes. This study aimed to identify the optimal oxygenation treatment for AAD patients with hypoxemia in the emergency department (ED).

Methods

This was a retrospective, observational, cohort study. We retrospectively collected data from 187 adult patients with AAD and hypoxemia who had been admitted to our ED. All patients were divided into nasal cannula group (n=91), Venturi mask group (n=60), and non-invasive positive pressure ventilation (NIPPV) group (n=36). The primary outcome was overall mortality in ED; the secondary outcomes were preoperative intubation rate and postoperative mortality, length of intensive care unit (ICU) stay, length of hospital stay, and length of intubation.

Results

Among all patients, those who received NIPPV treatment showed the lowest ED intubation rate (2.78%, P=0.004), shortest postoperative length of ICU stay (median 2.31, P<0.001), postoperative length of intubation (median 25.10, P<0.001), and post-operative length of hospital stay (median 21.00, P<0.001). Kaplan-Meier analysis showed the highest 3-day survival (log-rank 7.387, P=0.03) and 5-day survival (log-rank 14.710, P=0.001) in the NIPPV group. After adjustment, NIPPV therapy was independently associated with the reduced 3-day [adjusted hazard ratio (HR) 0.102, 95% confidence interval (CI): 0.013-0.791, P=0.03] and 5-day (adjusted HR 0.057, 95% CI: 0.008-0.427, P=0.005) mortality in ED.

Conclusions

Early utilization of NIPPV in AAD patients with hypoxemia in the ED can effectively decrease pre-operative intubation rate and perioperative mortality, and improve postoperative outcomes.

Extracorporeal membrane oxygenation in COVID-19- Associated acute respiratory distress syndrome - Outcome and experience in a tertiary care intensive care unit - A retrospective study

Background

Extracorporeal membrane oxygenation (ECMO) has been used in patients with severe acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) who fail conventional treatment.

Methods

A retrospective observational study was designed in patients who underwent ECMO for severe COVID-19 ARDS in a tertiary care centre from September 2020 to July 2021. The primary outcome was to assess factors influencing clinical outcomes and survival to hospital discharge. Secondary outcomes were to assess the clinical profile and pre-ECMO features, ECMO characteristics and complications. Collected data were entered in Excel software and analysed using R software version 4.0.2 (R foundation for statistical computing, Vienna, Austria).

Results

A total of 19 patients underwent ECMO. Ten patients survived and discharge. Survivors had a longer median (interquartile range [IQR]) duration (days) on ECMO, that is, 25 (7-50), compared to non-survivors, that is, 12 (1-34) (P = 0.133). We also noted that patients who survived had a longer median (IQR) duration (days) of intensive care unit (ICU) stay, that is, 41.5 (30-70), compared to non-survivors, that is, 9 (2-40) (P = 0.001).

Conclusion

In our study, 52.3% of patients survived and discharge, and with ECMO outcomes for COVID-19 ARDS were at par with ECMO outcomes for non-COVID-19 ARDS despite requiring ECMO for longer duration and increased ICU length of stay.