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Briones-Claudett KH, Briones-Claudett MH, Bajaña Huilcapi CK, Tripul Villamar OE, Ochoa Vásquez R, Rivera Salas CDR, Briones-Zamora KH, Benites Solis J, Briones-Márquez DC, Freire AX, Grunauer M. Surfactant therapy using vibrating-mesh nebulizers in adults with COVID-19-induced ARDS: A case series. SAGE Open Med Case Rep 2024; 12:2050313X241236313. [PMID: 38444695 PMCID: PMC10913513 DOI: 10.1177/2050313x241236313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
Coronavirus adult respiratory distress syndrome, characterized by decreased surfactant due to lysis of type II pneumocytes and hyaline membrane formation, contributes to severe hypoxemia. The administration of surfactant via high-flow nasal cannula (HFNC) may positively affect lung structure and function in this context. In this study, we report on five clinical cases, encompassing patients aged 40-60 years of both sexes, who tested positive for coronavirus disease 2019 via real-time polymerase chain reaction and exhibited significant pulmonary compromise with elevated inflammatory biomarkers. These patients were treated with aerosol therapy using surfactant delivered through vibrating-mesh nebulizers alongside HFNC. Of these patients, four demonstrated positive responses to the treatment, suggesting that aerosol therapy with surfactant through vibrating-mesh nebulizers could be a viable rescue therapy in adults receiving HFNC oxygen therapy for hypoxemic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, one patient had a negative outcome and succumbed. The findings from these cases indicate that the use of aerosol therapy with vibrating-mesh nebulizers as rescue therapy might offer an alternative approach for managing adults with hypoxemic respiratory failure due to SARS-CoV-2, as evidenced by the positive outcomes in four out of the five cases presented.
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Affiliation(s)
- Killen H Briones-Claudett
- Facultad de Medicina, Universidad de Las Americas, Quito, Ecuador
- Intensive Care Unit, Ecuadorian Institute of Social Security, Babahoyo, Ecuador
| | | | | | | | | | | | | | | | | | - Amado X Freire
- Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michelle Grunauer
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
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2
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Huth SF, Rothkopf A, Smith L, White N, Bassi GL, Suen JY, Fraser JF. Variability of oxygen requirements in critically ill COVID-19 patients. J Glob Health 2024; 14:05012. [PMID: 38390629 PMCID: PMC10884784 DOI: 10.7189/jogh.14.05012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background The global scarcity of medical oxygen has proven to be catastrophic during the surges in COVID-19 cases over the past two years, with the heaviest burden felt in low- and middle-income countries. Despite its criticality, data and analyses of oxygen consumption, even for typical clinical cases, are missing. Consequently, planning oxygen needs, particularly with variable surges in COVID-19 cases, has presented a substantial challenge to policymakers and hospital decision-makers. Methods We performed a sub-analysis of the COVID-19 Critical Care Consortium database assessing the oxygen consumption requirements of COVID-19 patients admitted to intensive care units between February 2020 and October 2021. We calculated descriptive statistics for oxygen flow-rates, stratified by oxygen supplementation method, and developed a multi-state model for estimating the frequency, therapy duration, probability of transition, and number of oxygen therapy modes per patient. Results Overall, 12 429 patients from 35 countries received oxygen support on at least one day of their hospitalisation. Of the patients with measurable flow rates, 6142 received invasive mechanical ventilation, 838 received high-flow nasal oxygen, and 257 received both modalities. The median flow rate for mechanical ventilation was 3.2 L per minute (interquartile range (IQR) = 2.0-4.9), with a median duration of 12 days (IQR = 6-24), while the median flow rate for high-flow nasal cannula was 40 L per minute (IQR = 15-55), with a median duration of three days (IQR = 2-6). Conclusions Oxygen consumption among critical COVID-19 patients varies by mode of delivery (invasive ventilation vs high-flow nasal cannula), across patients, and over treatment duration. Therefore, it is essential that health facilities routinely monitor oxygen utilization to better inform oxygen delivery system design and regular supply planning. Registration ClinicalTrials.gov: CTG2021-01 ACTRN12620000421932.
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Affiliation(s)
- Samuel F Huth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Nicole White
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia
- Wesley Medical Research, Brisbane, Australia
| | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- St Andrew's War Memorial Hospital, UnitingCare Hospitals, Brisbane, Australia
- Wesley Medical Research, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, Australia
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3
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Doubravská L, Htoutou Sedláková M, Fišerová K, Klementová O, Turek R, Langová K, Kolář M. Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study. Antibiotics (Basel) 2024; 13:192. [PMID: 38391578 PMCID: PMC10886267 DOI: 10.3390/antibiotics13020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).
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Affiliation(s)
- Lenka Doubravská
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Miroslava Htoutou Sedláková
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Fišerová
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Olga Klementová
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Radovan Turek
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Milan Kolář
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
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4
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Artaud-Macari E, Le Bouar G, Maris J, Dantoing E, Vatignez T, Girault C. [Ventilatory management of SARS-CoV-2 acute respiratory failure]. Rev Mal Respir 2023; 40:751-767. [PMID: 37865564 DOI: 10.1016/j.rmr.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/19/2023] [Indexed: 10/23/2023]
Abstract
COVID-19 pneumonia presents several particularities in its clinical presentation (cytokine storm, silent hypoxemia, thrombo-embolic risk) and may lead to a number of acute respiratory distress syndrome (ARDS) phenotypes. While the optimal oxygenation strategy in cases of hypoxemic acute respiratory failure (ARF) is still under debate, ventilatory management of COVID-19-related ARF has confirmed the efficacy of high-flow oxygen therapy and restored interest in other ventilatory approaches such as continuous positive airway pressure (CPAP) and noninvasive ventilation involving a helmet, which due to patient overflow are sometimes implemented outside of critical care units. However, further studies are still needed to determine which patients should be given which oxygenation technique, and under which conditions they require invasive mechanical ventilation, given that delayed initiation potentially burdens prognosis. During invasive mechanical ventilation, ventral decubitus and extracorporeal membrane oxygenation have become increasingly prevalent. While innovative therapies such as awake prone position or lung transplantation have likewise been developed, their indications, modalities and efficacy remain to be determined.
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Affiliation(s)
- E Artaud-Macari
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France; UNIROUEN, UR-3830, Normandie université, CHU de Rouen, 76000 Rouen, France.
| | - G Le Bouar
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - J Maris
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - E Dantoing
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - T Vatignez
- Service de médecine intensive et réanimation, CHU de Rouen, 76000 Rouen, France
| | - C Girault
- UNIROUEN, UR-3830, Normandie université, CHU de Rouen, 76000 Rouen, France; Service de médecine intensive et réanimation, CHU de Rouen, 76000 Rouen, France
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Wu CC, Chen WL, Tseng CW, Su YC, Chen HL, Lin CL, Hung TY. Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy. Sci Rep 2023; 13:15910. [PMID: 37741874 PMCID: PMC10517922 DOI: 10.1038/s41598-023-42909-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023] Open
Abstract
This study evaluated the aerosol exposure risks while using common noninvasive oxygenation devices. A simulated mannequin was designed to breathe at a minute ventilation of 20 L/min and used the following oxygen-therapy devices: nasal cannula oxygenation (NCO) at 4 and 15 L/min, nonrebreathing mask (NRM) at 15 L/min, simple mask at 6 L/min, combination of NCO at 15 L/min and NRM at 15 L/min, high-flow nasal cannula (HFNC) at 50 L/min, and flush rate NRM. Two-dimension of the dispersion distance and the aerosol concentrations were measured at head, trunk, and foot around the mannequin for over 10 min. HFNC and flush-rate NRM yielded the longest dispersion distance and highest aerosol concentrations over the three sites of the mannequin than the other oxygenation devices and should use with caution. For flow rates of < 15 L/min, oxygenation devices with mask-like effects, such as NRM or NCO with NRM, decreased aerosol dispersion more effectively than NCO alone or a simple mask. In the upright position, the foot area exhibited the highest aerosol concentration regardless of the oxygenation device than the head-trunk areas of the mannequin. Healthcare workers should be alert even at the foot side of the patient while administering oxygenation therapy.
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Affiliation(s)
- Chih-Chieh Wu
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Wei-Lun Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Cheng-Wei Tseng
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Yung-Cheng Su
- School of Medicine, Tzu Chi University, Hualien County, Hualien, Taiwan
- Department of Emergency, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chiayi County, Chiayi, Taiwan
| | - Hsin-Ling Chen
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Lung Lin
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan
| | - Tzu-Yao Hung
- Department of Emergency Medicine, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan.
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
- CrazyatLAB (Critical Airway Training Laboratory), Taipei, Taiwan.
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6
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Du Y, Zhao F, Tao R, Liu B. Effect of forceful suction and air disinfection machines on aerosol removal. BMC Oral Health 2023; 23:652. [PMID: 37684672 PMCID: PMC10492290 DOI: 10.1186/s12903-023-03369-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUNDS Dental procedures involving drilling and grinding can produce a significant amount of suspended aerosol particles (PM) and bioaerosols. This study aims to analyze the size and concentration of aerosol particles generated during drilling and to investigate the effectiveness of two air exchange systems, namely forceful suction (FS) and air disinfection machines (DM), in removing PM. METHODS For this study, 100 extracted permanent teeth were collected and divided into three groups: without suction (n = 50), suction with forceful suction (n = 25), and suction with air disinfection machines (n = 25). The removal rate of suspended aerosol particles was analyzed using particle counters and air data multimeter. RESULTS When drilling and grinding were performed without vacuum, 0.75% of the aerosol particles generated were PM2.5-10, 78.25% of total suspended aerosol particles (TSP) were PM2.5, and 98.68% of TSP were PM1. The nanoanalyzer measurements revealed that the aerodynamic diameter of most aerosol particles was below 60 nm, with an average particle diameter of 52.61 nm and an average concentration of 2.6*1011 ultrafine aerosol particles. The air change per hour (ACH) was significantly lower in the air disinfection machines group compared to the forceful suction group. Additionally, the number of aerosol particles and mass concentration was significantly lower in the air disinfection machines group compared to the forceful suction group in terms of PM2.5 levels. However, the forceful suction group also reduced the mass concentration in PM10 level than the air disinfection machines group. CONCLUSION In conclusion, the air exchange system can reduce the aerosol particles generated during drilling and grinding. Comparing the two air exchange systems, it was found that the air disinfection machines group reduces the number of aerosol particles and mass concentration in PM2.5 levels, while the forceful suction group reduces the mass concentration in PM10 level.
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Affiliation(s)
- Yaru Du
- Department of hospital allergy, Medical department, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Fei Zhao
- Department of Periodontal I, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Ran Tao
- Medical department, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, PR China
| | - Bing Liu
- Department of Periodontal I, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School and Hospital of Stomatology, Hebei Medical University, Shijiazhuang, 050017, PR China.
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7
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Phan AMV, Hoang HYT, Truong Do TS, Hoang TQ, Phan TV, Huynh NAP, Minh Le K. High-flow nasal cannula therapy in patients with COVID-19 in intensive care units in a country with limited resources: a single-center experience. J Int Med Res 2023; 51:3000605231193580. [PMID: 37607569 PMCID: PMC10467390 DOI: 10.1177/03000605231193580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE This study was performed to determine the outcomes of patients with coronavirus disease 2019 (COVID-19) who developed hypoxemic respiratory failure necessitating high-flow nasal cannula (HFNC) therapy and to identify the predictors of HFNC therapy success. METHODS This retrospective observational study involved all patients treated with HFNC therapy at a center for COVID-19 in Viet Nam from August to October 2021. RESULTS The study recruited 302 patients. Of these 302 patients, 171 (56.6%) underwent successful HFNC therapy, and the all-cause mortality rate was 33.44%. Non-critical COVID-19 and a higher respiratory rate-oxygenation (ROX) index at 48 hours after initiating HFNC therapy were independently correlated with HFNC therapy success. The statistically significant predictors of HFNC therapy success were younger age, non-critical COVID-19, a higher platelet count when starting HFNC therapy, and a higher ROX index at 24, 36, and 48 hours after HFNC therapy initiation. CONCLUSIONS HFNC therapy appears to be effective in patients with COVID-19 who develop respiratory failure requiring respiratory support. Non-critical COVID-19 and a higher ROX index measured 48 hours after HFNC therapy initiation might serve as predictive factors for the success of HFNC therapy.
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Affiliation(s)
- Anh-Minh Vu Phan
- Intensive Care Unit, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Hai-Yen Thi Hoang
- Intensive Care Unit, University Medical Center, Ho Chi Minh City, Viet Nam
| | | | - Trung Quoc Hoang
- Cardiovascular Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Thuan Van Phan
- Cardiovascular Center, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Nguyet-Anh Phuong Huynh
- Department of Trauma and Plastic Surgery, University Medical Center, Ho Chi Minh City, Viet Nam
| | - Khoi Minh Le
- Cardiovascular Center, University Medical Center, Ho Chi Minh City, Viet Nam
- Department of Critical Care Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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8
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Bime C, Carr GE, Pu J, Kou S, Wang Y, Simons M. Delayed intubation associated with in-hospital mortality in patients with COVID-19 respiratory failure who fail heated and humified high flow nasal canula. BMC Anesthesiol 2023; 23:234. [PMID: 37438685 DOI: 10.1186/s12871-023-02198-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/05/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Advanced respiratory support modalities such as non-invasive positive pressure ventilation (NiPPV) and heated and humidified high flow nasal canula (HFNC) served as useful alternatives to invasive mechanical ventilatory support for acute respiratory failure (ARF) during the peak of the SARS-CoV-2/COVID-19 pandemic. Unlike NiPPV, HFNC is a newer modality and its role in the treatment of patients with severe ARF is not yet clearly defined. Furthermore, the characteristics of responders versus non-responders to HFNC have not been determined. Although recent evidence indicates that many patients with ARF treated with HFNC survive without needing intubation, those who fail and are subsequently intubated have worse outcomes. Given that prolonged use of HFNC in patients with ARF might exacerbate patient self-inflicted lung injury, we hypothesized that among those patients with ARF due to COVID-19 pneumonia, prolonged HFNC beyond 24 h before intubation would be associated with increased in-hospital mortality. METHODS This was a retrospective, multicenter, observational cohort study of 2720 patients treated for ARF secondary to SARS-CoV-2/COVID-19 pneumonia and initially managed with HFNC within the Banner Health system during the period from March 1st, 2020, to July 31st, 2021. In the subgroup of patients for went from HFNC to IMV, we assessed the effect of the duration of HFNC prior to intubation on mortality. RESULTS 1392 (51%) were successfully treated with HFNC alone and 1328 (49%) failed HFNC and were intubated (HFNC to IMV). When adjusted for the covariates, HFNC duration less than 24 h prior to intubation was significantly associated with reduced mortality. CONCLUSIONS Among patients with ARF due to COVID-19 pneumonia who fail HFNC, delay of intubation beyond 24 h is associated with increased mortality.
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Affiliation(s)
- Christian Bime
- University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Gordon E Carr
- University of Arizona College of Medicine, Tucson, AZ, USA
- Banner Health, Phoenix, AZ, USA
| | - Jie Pu
- Banner Health, Phoenix, AZ, USA
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9
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Jalil Y, Ferioli M, Dres M. The COVID-19 Driving Force: How It Shaped the Evidence of Non-Invasive Respiratory Support. J Clin Med 2023; 12:jcm12103486. [PMID: 37240592 DOI: 10.3390/jcm12103486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
During the COVID-19 pandemic, the use of non-invasive respiratory support (NIRS) became crucial in treating patients with acute hypoxemic respiratory failure. Despite the fear of viral aerosolization, non-invasive respiratory support has gained attention as a way to alleviate ICU overcrowding and reduce the risks associated with intubation. The COVID-19 pandemic has led to an unprecedented increased demand for research, resulting in numerous publications on observational studies, clinical trials, reviews, and meta-analyses in the past three years. This comprehensive narrative overview describes the physiological rationale, pre-COVID-19 evidence, and results of observational studies and randomized control trials regarding the use of high-flow nasal oxygen, non-invasive mechanical ventilation, and continuous positive airway pressure in adult patients with COVID-19 and associated acute hypoxemic respiratory failure. The review also highlights the significance of guidelines and recommendations provided by international societies and the need for further well-designed research to determine the optimal use of NIRS in treating this population.
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Affiliation(s)
- Yorschua Jalil
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Martina Ferioli
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine (DIMES), Alma Mater Studiorum University of Bologna, 40136 Bologna, Italy
| | - Martin Dres
- INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, 75006 Paris, France
- Service de Médecine Intensive-Réanimation (Département "R3S"), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France
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10
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Morishita M, Hojo M. Treatment options for patients with severe COVID-19. Glob Health Med 2023; 5:99-105. [PMID: 37128231 PMCID: PMC10130548 DOI: 10.35772/ghm.2023.01024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected the world for over 3 years. Treatment options have improved substantially during this period, including antiviral drugs, antibody drugs, immune-based agents, and vaccination. While these improvements have reduced mortality rates in patients with COVID-19, some patients still develop severe illness. In this review, we aimed to provide an overview of treatments for patients with severe COVID-19 from study reports and clinical experience. We discussed the treatments from two perspectives: respiratory care and drug treatments. In the respiratory care section, we discussed the usefulness of high-flow nasal cannula therapy and non-invasive ventilation as an alternative to invasive ventilation. In the drug treatments section, we focused on three classes for severe COVID-19 treatment: antiviral drugs, immune-based agents, and anticoagulation therapy. We did not discuss antibody drugs and vaccination, as they are not used for severe COVID-19 treatment.
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Affiliation(s)
| | - Masayuki Hojo
- Address correspondence to:Masayuki Hojo, Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
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Hermann B, Benghanem S, Jouan Y, Lafarge A, Beurton A. The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists. Ann Intensive Care 2023; 13:28. [PMID: 37039936 PMCID: PMC10088619 DOI: 10.1186/s13613-023-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023] Open
Abstract
Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better.
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Affiliation(s)
- Bertrand Hermann
- Service de Médecine Intensive - Réanimation, Hôpital Européen Georges Pompidou (HEGP), Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
| | - Sarah Benghanem
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Cochin, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive - Réanimation, CHRU Tours, Tours, France
- Service de Réanimation Chirurgicale Cardiovasculaire & Chirurgie Cardiaque, CHRU Tours, Tours, France
- INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine de Tours, Tours, France
| | - Antoine Lafarge
- Faculté de Médecine, Université Paris Cité, Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Saint Louis, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Nord - Université Paris Cité (AP-HP Nord - Université Paris Cité), Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive - Réanimation, Hôpital Tenon, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université (GHU AP-HP Sorbonne Université), Paris, France.
- Service de Médecine Intensive - Réanimation, Hôpital Pitié Salpêtrière, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
- UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
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12
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Yu PT, Chen CH, Wang CJ, Kuo KC, Wu JC, Chung HP, Chen YT, Tang YH, Chang WK, Lin CY, Wu CL. Predicting the successful application of high-flow nasal oxygen cannula in patients with COVID-19 respiratory failure: a retrospective analysis. Expert Rev Respir Med 2023; 17:319-328. [PMID: 37002880 DOI: 10.1080/17476348.2023.2199157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND The right time of high-flow nasal cannulas (HFNCs) application in COVID-19 patients with acute respiratory failure remains uncertain. RESEARCH DESIGN AND METHODS In this retrospective study, COVID-19-infected adult patients with hypoxemic respiratory failure were enrolled. Their baseline epidemiological data and respiratory failure related parameters, including the Ventilation in COVID-19 Estimation (VICE), and the ratio of oxygen saturation (ROX index), were recorded. The primary outcome measured was the 28-day mortality. RESULTS A total of 69 patients were enrolled. Fifty-four (78%) patients who intubated and received invasive mechanical ventilatory (MV) support on day 1 were enrolled in the MV group. The remaining fifteen (22%) patients received HFNC initially (HFNC group), in which, ten (66%) patients were not intubated during hospitalization were belong to HFNC-success group and five (33%) of these patients were intubated later due to disease progression were attributed to HFNC-failure group. Compared with those in the MV group, those in the HFNC group had a lower mortality rate (6.7% vs. 40.7%, p = 0.0138). There were no differences in baseline characteristics among the two groups; however, the HFNC group had a lower VICE score (0.105 [0.049-0.269] vs. 0.260 [0.126-0.693], p = 0.0092) and higher ROX index (5.3 [5.1-10.7] vs. 4.3 [3.9-4.9], p = 0.0007) than the MV group. The ROX index was higher in the HFNC success group immediately before (p = 0.0136) and up to 12 hours of HFNC therapy than in the HFNC failure group. CONCLUSIONS Early intubation may be considered in patients with a higher VICE score or a lower ROX index. The ROX score during HFNCs use can provide an early warning sign of treatment failure. Further investigations are warranted to confirm these results.
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Affiliation(s)
- Ping-Tsung Yu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chao-Hsien Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chieh-Jen Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Kuan-Chih Kuo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Jou-Chun Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hsin-Pei Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yen-Ting Chen
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yen-Hsiang Tang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Kuei Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chang-Yi Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Chien-Liang Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
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13
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Pereira LFT, Dallagnol CA, Moulepes TH, Hirota CY, Kutsmi P, Dos Santos LV, Pirich CL, Picheth GF. Oxygen therapy alternatives in COVID-19: From classical to nanomedicine. Heliyon 2023; 9:e15500. [PMID: 37089325 PMCID: PMC10106793 DOI: 10.1016/j.heliyon.2023.e15500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
Around 10-15% of COVID-19 patients affected by the Delta and the Omicron variants exhibit acute respiratory insufficiency and require intensive care unit admission to receive advanced respiratory support. However, the current ventilation methods display several limitations, including lung injury, dysphagia, respiratory muscle atrophy, and hemorrhage. Furthermore, most of the ventilatory techniques currently offered require highly trained professionals and oxygen cylinders, which may attain short supply owing to the high demand and misuse. Therefore, the search for new alternatives for oxygen therapeutics has become extremely important for maintaining gas exchange in patients affected by COVID-19. This review highlights and suggest new alternatives based on micro and nanostructures capable of supplying oxygen and/or enabling hematosis during moderate or acute COVID-19 cases.
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Affiliation(s)
- Luis F T Pereira
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Camila A Dallagnol
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Tassiana H Moulepes
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Clara Y Hirota
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Pedro Kutsmi
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
| | - Lucas V Dos Santos
- Department of Biochemistry, Federal University of Paraná, Curitiba, PR, Brazil
| | - Cleverton L Pirich
- Department of Bioprocess Engineering and Biotechnology, Federal University of Paraná, Curitiba, PR, Brazil
| | - Guilherme F Picheth
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, PR, Brazil
- Department of Biochemistry, Federal University of Paraná, Curitiba, PR, Brazil
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14
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Katsuno T, Suzuki M, Morishita M, Kawajiri K, Saito S, Horikawa Y, Ueki Y, Yamaguchi Y, Takumida H, Watanabe H, Morita C, Tsukada A, Kusaba Y, Tsujimoto Y, Ishida A, Sakamoto K, Hashimoto M, Terada J, Takasaki J, Izumi S, Hojo M, Sugiyama H. High-flow nasal cannula for severe COVID-19 patients in a Japanese single-center, retrospective, observational study: 1 year of clinical experience. Glob Health Med 2023; 5:47-53. [PMID: 36865899 PMCID: PMC9974223 DOI: 10.35772/ghm.2022.01054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
High-flow nasal cannula (HFNC) can be effective in treating type 1 respiratory failure by reducing the severity of coronavirus disease 2019 (COVID-19). The purpose of this study was to assess the reduction of disease severity and safety of HFNC treatment in patients with severe COVID-19. We retrospectively observed 513 consecutive patients with COVID-19 admitted to our hospital from January 2020 to January 2021. We included patients with severe COVID-19 who received HFNC for their deteriorating respiratory status. HFNC success was defined as improvement in respiratory status after HFNC and transfer to conventional oxygen therapy, while HFNC failure was defined as transfer to non-invasive positive pressure ventilation or ventilator, or death after HFNC. Predictive factors associated with failure to prevent severe disease were identified. Thirty-eight patients received HFNC. Twenty-five (65.8%) patients were classified in the HFNC success group. In the univariate analysis, age, history of chronic kidney disease (CKD), non-respiratory sequential organ failure assessment (SOFA) ≥ 1, oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) before HFNC ≤ 169.2, were significant predictors of HFNC failure. Multivariate analysis revealed that SpO2/FiO2 value before HFNC ≤ 169.2 was an independent predictor of HFNC failure. No apparent nosocomial infection occurred during the study period. Appropriate use of HFNC for acute respiratory failure caused by COVID-19 can reduce the severity of severe disease without causing nosocomial infection. Age, history of CKD, non-respiratory SOFA before HFNC ≤ 1, and SpO2/FiO2 before HFNC ≤ 169.2 were associated with HFNC failure.
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Affiliation(s)
| | - Manabu Suzuki
- Address correspondence to:Manabu Suzuki, Department of Respiratory Medicine, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
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15
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Briones-Claudett KH, Briones-Claudett MH, Martinez Armijos EA, Rios-Marcillo JJ, Orozco Holguin LA, Briones-Zamora KH, Briones-Marquez DC, Icaza-Freire AP, Grunauer M. Use of threshold PEP with an adult non-rebreather oxygen mask plus prone positioning in acute hypoxemic respiratory failure due to SARS-CoV-2 infection during the collapse of the health system in a low-income country. SAGE Open Med Case Rep 2023; 11:2050313X231154064. [PMID: 36816823 PMCID: PMC9936171 DOI: 10.1177/2050313x231154064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/14/2023] [Indexed: 02/18/2023] Open
Abstract
During the coronavirus disease 2019 pandemic, Ecuador reported a collapse of the healthcare system, in which intensive care unit beds were lacking. Therefore, we sought to determine whether the use of threshold expiratory positive pressure with an adult non-rebreather oxygen mask plus prone positioning is useful for improving oxygenation. Twelve patients were included. Eight patients (66.7%) survived, while four patients (33.3%) died. Baseline arterial oxygen saturation (%) prior placement median (interquartile range) 85.5% (80%-89%) and arterial oxygen saturation (%) post placement of the device was median (interquartile range) (93%-96%) (P = 0.0001). Respiratory rate before placement was median (interquartile range) 38 (36-42) and post placement of the device was median (interquartile range) 24 (22-30) (P = 0.0005). The use of an adapted device might be useful for the management of acute hypoxemic respiratory failure due to severe acute respiratory syndrome coronavirus 2 pneumonia, particularly when mechanical ventilators and high-flow oxygen systems are unavailable.
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Affiliation(s)
- Killen H Briones-Claudett
- Facultad de Medicina, Universidad de Las Americas, Quito, Ecuador,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador,Killen H. Briones-Claudett, Facultad de Medicina, Universidad de Las Americas, Redondel del Ciclista, Antigua Vía a Nayron, Quito 170124, Ecuador. Emails: ; ; ;
| | | | | | - Jorge J Rios-Marcillo
- Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | | | | | | | | | - Michelle Grunauer
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
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16
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Frat JP, Marchasson L, Arrivé F, Coudroy R. High-flow nasal cannula oxygen therapy in acute hypoxemic respiratory failure and COVID-19-related respiratory failure. JOURNAL OF INTENSIVE MEDICINE 2023; 3:20-26. [PMID: 36756183 PMCID: PMC9534601 DOI: 10.1016/j.jointm.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/19/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Although standard oxygen face masks are first-line therapy for patients with acute hypoxemic respiratory failure, high-flow nasal cannula oxygen therapy has gained major popularity in intensive care units. The physiological effects of high-flow oxygen counterbalance the physiological consequences of acute hypoxemic respiratory failure by lessening the deleterious effects of intense and prolonged inspiratory efforts generated by patients. Its simplicity of application for physicians and nurses and its comfort for patients are other arguments for its use in this setting. Although clinical studies have reported a decreased risk of intubation with high-flow oxygen compared with standard oxygen, its survival benefit is uncertain. A more precise definition of acute hypoxemic respiratory failure, including a classification of severity based on oxygenation levels, is needed to better compare the efficiencies of different non-invasive oxygenation support methods (standard oxygen, high-flow oxygen, and non-invasive ventilation). Additionally, the respective role of each non-invasive oxygenation support method needs to be established through further clinical trials in acute hypoxemic respiratory failure, especially in severe forms.
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Affiliation(s)
- Jean-Pierre Frat
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers 86021, France,Centre d'Investigation Clinique 1402 ALIVE, INSERM, Université de Poitiers, Poitiers 86021, France,Corresponding author: Jean-Pierre Frat, Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers 86021, France
| | - Laura Marchasson
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers 86021, France
| | - François Arrivé
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers 86021, France
| | - Rémi Coudroy
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers 86021, France,Centre d'Investigation Clinique 1402 ALIVE, INSERM, Université de Poitiers, Poitiers 86021, France
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17
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O'Hayer PJ, Vasbinder A, Anderson E, Catalan T, Bitterman B, Khaleel I, Erne G, Tekumulla A, Tilley C, Presswalla F, Nelapudi N, Chen J, Tripathi M, Rochlen M, Rambo L, Sulaiman N, Blakely P, Huang Y, Zhao L, Pop-Busui R, Hayek SS. Evolution of Care and Outcomes Across Surges in Hospitalized Patients with Coronavirus Disease 2019. Am J Med 2023; 136:63-71.e1. [PMID: 36150511 PMCID: PMC9489963 DOI: 10.1016/j.amjmed.2022.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has unfolded in distinct surges. Understanding how surges differ may reveal important insights into the evolution of the pandemic and improve patient care. METHODS We leveraged the Michigan Medicine COVID-19 Cohort, a prospective observational study at an academic tertiary medical center that systematically enrolled 2309 consecutive patients hospitalized for COVID-19, comprising 5 distinct surges. RESULTS As the pandemic evolved, patients hospitalized for COVID-19 tended to have a lower burden of comorbidities and a lower inflammatory burden as measured by admission levels of C-reactive protein, ferritin, lactate dehydrogenase, and D-dimer. Use of hydroxychloroquine and azithromycin decreased substantially after Surge 1, while use of corticosteroids and remdesivir markedly increased (P < .001 for all). In-hospital mortality significantly decreased from 18.3% in Surge 1 to 5.3% in Surge 5 (P < .001). The need for mechanical ventilation significantly decreased from 42.5% in Surge 1 to 7.0% in Surge 5 (P < .001), while the need for renal replacement therapy decreased from 14.4% in Surge 1 to 2.3% in Surge 5 (P < .001). Differences in patient characteristics, treatments, and inflammatory markers accounted only partially for the differences in outcomes between surges. CONCLUSIONS The COVID-19 pandemic has evolved significantly with respect to hospitalized patient populations and therapeutic approaches, and clinical outcomes have substantially improved. Hospitalization after the first surge was independently associated with improved outcomes, even after controlling for relevant clinical covariates.
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Affiliation(s)
| | | | | | | | | | | | - Grace Erne
- Department of Medicine, Division of Cardiology
| | | | | | | | | | - Jiazi Chen
- Department of Medicine, Division of Cardiology
| | | | | | - Loni Rambo
- Department of Medicine, Division of Cardiology
| | | | | | - Yiyuan Huang
- Department of Biostatistics, School of Public Health
| | - Lili Zhao
- Department of Biostatistics, School of Public Health
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor
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18
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Mehmood R, Mansoor Z, Atanasov GP, Cheian A, Davletova A, Patel A, Ahmed D. High-Flow Nasal Oxygenation and Its Applicability in COVID Patients. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 4:49. [PMID: 35128319 PMCID: PMC8801314 DOI: 10.1007/s42399-022-01132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 11/24/2022]
Abstract
High-flow nasal oxygenation (HFNO) is a type of oxygen therapy that provides humidified and heated oxygen through a nasal cannula at much higher flow rates than standard oxygen therapy, while also allowing control over the fraction of inspired oxygen (FIO2). Compared to standard oxygen therapy, it is much more comfortable for the patient and seems to alleviate most of the problems associated with standard oxygen therapy, such as dry nose, dry throat and nasal pain. It also provides a variety of benefits that can reduce the incidence of escalating treatment and initiating mechanical ventilation in COVID patients with acute hypoxemic respiratory failure (AHRF). This article provides an overview of HFNO and its current applications in COVID patients during the pandemic.
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Affiliation(s)
- Raafay Mehmood
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zainab Mansoor
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Alexei Cheian
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alina Davletova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
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19
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McGrath JA, O’Sullivan A, Joyce M, Byrne MA, Li J, Fink JB, MacLoughlin R. In vitro model for investigating aerosol dispersion in a simulated COVID-19 patient during high-flow nasal cannula treatment. Front Med (Lausanne) 2022; 9:1002659. [PMID: 36530866 PMCID: PMC9751314 DOI: 10.3389/fmed.2022.1002659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/14/2022] [Indexed: 08/05/2023] Open
Abstract
The use of high-flow nasal cannula in the treatment of COVID-19 infected patients has proven to be a valuable treatment option to improve oxygenation. Early in the pandemic, there were concerns for the degree of risk of disease transmission to health care workers utilizing these treatments that are considered aerosol generating procedures. This study developed an in vitro model to examine the release of simulated patient-derived bioaerosol with and without high-flow nasal cannula at gas flow rates of 30 and 50 L/min. Aerosol dispersion was evaluated at 30 and 90 cm distances. Reduction of transmission risk was assessed using a surgical facemask on the manikin. Results indicated that the use of a facemask facilitated a 94-95% reduction in exhaled aerosol concentration at 30 cm and 22-60% reduction for 90 cm distance across both gas flow rates. This bench study confirms that this in vitro model can be used as a tool to assess the risk of disease transmission during aerosol generating procedures in a simulated patient and to test factors to mitigate the risk.
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Affiliation(s)
- James A. McGrath
- Department of Physics, School of Natural Science, Ryan Institute’s Centre for Climate & Air Pollution Studies, University of Galway, Galway, Ireland
| | - Andrew O’Sullivan
- Research & Development, Science & Emerging Technologies, Aerogen Limited, Galway, Ireland
| | - Mary Joyce
- Research & Development, Science & Emerging Technologies, Aerogen Limited, Galway, Ireland
| | - Miriam A. Byrne
- Department of Physics, School of Natural Science, Ryan Institute’s Centre for Climate & Air Pollution Studies, University of Galway, Galway, Ireland
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, Chicago, IL, United States
| | - James B. Fink
- Aerogen Pharma Corporation, San Mateo, CA, United States
| | - Ronan MacLoughlin
- Research & Development, Science & Emerging Technologies, Aerogen Limited, Galway, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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20
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Wyatt KD, Goel NN, Whittle JS. Recent advances in the use of high flow nasal oxygen therapies. Front Med (Lausanne) 2022; 9:1017965. [PMID: 36300187 PMCID: PMC9589055 DOI: 10.3389/fmed.2022.1017965] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
High flow nasal oxygen is a relatively new option for treating patients with respiratory failure, which decreases work of breathing, improves tidal volume, and modestly increases positive end expiratory pressure. Despite well-described physiologic benefits, the clinical impact of high flow nasal oxygen is still under investigation. In this article, we review the most recent findings on the clinical efficacy of high flow nasal oxygen in Type I, II, III, and IV respiratory failure within adult and pediatric patients. Additionally, we discuss studies across clinical settings, including emergency departments, intensive care units, outpatient, and procedural settings.
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Affiliation(s)
- Kara D. Wyatt
- Scientific Consultant, Chattanooga, TN, United States
| | - Neha N. Goel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica S. Whittle
- Department of Emergency Medicine, University of Tennessee, Chattanooga, TN, United States
- Vapotherm, Inc., Exeter, NH, United States
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21
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The optimal management of the patient with COVID‐19 pneumonia: HFNC, NIV/CPAP or mechanical ventilation? Afr J Thorac Crit Care Med 2022; 28. [DOI: 10.7196/ajtccm.2022.v28i3.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/07/2022] Open
Abstract
The recent pandemic has seen unprecedented demand for respiratory support of patients with COVID‐19 pneumonia, stretching services and clinicians. Yet despite the global numbers of patients treated, guidance is not clear on the correct choice of modality or the timing of escalation of therapy for an individual patient.This narrative review assesses the available literature on the best use of different modalities of respiratory support for an individual patient, and discusses benefits and risks of each, coupled with practical advice to improve outcomes.
On current data, in an ideal context, it appears that as disease severity worsens, conventional oxygen therapy is not sufficient alone. In more severe disease, i.e. PaO2/FiO2 ratios below approximately 200, helmet‐CPAP (continuous positive airway pressure) (although not widely available) may be superior to high‐flow nasal cannula (HFNC) therapy or facemask non‐invasive ventilation (NIV)/CPAP, and that facemask NIV/CPAP may be superior to HFNC, but with noted important complications, including risk of pneumothoraces.
In an ideal context, invasive mechanical ventilation should not be delayed where indicated and available. Vitally, the choice of respiratory support should not be prescriptive but contextualised to each setting, as supply and demand of resources vary markedly between institutions. Over time, institutions should develop clear policies to guide clinicians before demand exceeds supply, and should frequently review best practice as evidence matures.
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22
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Reyes LF, Murthy S, Garcia-Gallo E, Merson L, Ibáñez-Prada ED, Rello J, Fuentes YV, Martin-Loeches I, Bozza F, Duque S, Taccone FS, Fowler RA, Kartsonaki C, Gonçalves BP, Citarella BW, Aryal D, Burhan E, Cummings MJ, Delmas C, Diaz R, Figueiredo-Mello C, Hashmi M, Panda PK, Jiménez MP, Rincon DFB, Thomson D, Nichol A, Marshall JC, Olliaro PL. Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study. Crit Care 2022; 26:276. [PMID: 36100904 PMCID: PMC9469080 DOI: 10.1186/s13054-022-04155-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). METHODS This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. RESULTS A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). CONCLUSIONS In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable.
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Affiliation(s)
- Luis Felipe Reyes
- Pandemic Sciences Institute, University of Oxford, Oxford, UK.
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia.
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia.
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Laura Merson
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Elsa D Ibáñez-Prada
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Yuli V Fuentes
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
- Critical Care Department, Clínica Universidad de La Sabana, Chía, Colombia
| | - Ignacio Martin-Loeches
- Department of Clinical Medicine, St James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| | - Fernando Bozza
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), Rio de Janeiro, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Sara Duque
- Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia
| | - Fabio S Taccone
- Department of Intensive Care, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Laboratoire de Recherche Experimentale, Department of Intensive Care, Hôpital Erasme, Brussels, Belgium
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia, Depok, Indonesia
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Rodrigo Diaz
- Intensive Care Unit, Clinica Las Condes, Santiago, Chile
| | | | - Madiha Hashmi
- Critical Care Asia and Ziauddin University, Karachi, Pakistan
| | | | | | | | - David Thomson
- Division of Critical Care, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alistair Nichol
- University College Dublin Clinical Research Centre at St Vincent's University Hospital, Dublin, Ireland
| | - John C Marshall
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Piero L Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
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23
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Application of High-Flow Nasal Cannula in COVID-19: A Narrative Review. Life (Basel) 2022; 12:life12091419. [PMID: 36143455 PMCID: PMC9505799 DOI: 10.3390/life12091419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023] Open
Abstract
Background: During the first wave of COVID-19, the large influx of severely ill patients led to insufficient availability of beds in intensive care units and a shortage of ventilators. The shortage of ventilators, high mortality of intubated patients, and high risk of infections among healthcare workers involved in intubation were the main factors that led to the prevalence of noninvasive respiratory support during the pandemic. The high-flow nasal cannula (HFNC) is a commonly used, popular form of noninvasive respiratory support. Due to its unique physiological effects, HFNC can provide a high fraction of humidified oxygen and is satisfactorily comfortable for patients with COVID-19. However, before the COVID-19 era, there was little evidence on the application of HFNC in patients with acute respiratory failure caused by viral infection. Aim: This narrative review provides an overview of recent studies on the use of HFNC in patients with COVID-19-related acute hypoxemic respiratory failure. The main topics discussed include the probability of successful use of HFNC in these patients, whether late intubation increases mortality, the availability of convenient and accurate monitoring tools, comparison of HFNC with other types of noninvasive respiratory support, whether HFNC combined with the prone position is more clinically useful, and strategies to further reduce the infection risk associated with HFNC. The implication of this study is to identify some of the limitations and research gaps of the current literature and to give some advice for future research.
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24
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Chavez S, Brady WJ, Gottlieb M, Carius BM, Liang SY, Koyfman A, Long B. Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation. Am J Emerg Med 2022; 58:43-51. [PMID: 35636042 PMCID: PMC9106422 DOI: 10.1016/j.ajem.2022.05.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. OBJECTIVE This narrative review provides emergency clinicians with a focused update of the resuscitation and airway management of COVID-19. DISCUSSION Patients with COVID-19 and septic shock should be resuscitated with buffered/balanced crystalloids. If hypotension is present despite intravenous fluids, vasopressors including norepinephrine should be initiated. Stress dose steroids are recommended for patients with severe or refractory septic shock. Airway management is the mainstay of initial resuscitation in patients with COVID-19. Patients with COVID-19 and ARDS should be managed similarly to those ARDS patients without COVID-19. Clinicians should not delay intubation if indicated. In patients who are more clinically stable, physicians can consider a step-wise approach as patients' oxygenation needs escalate. High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) are recommended over elective intubation. Prone positioning, even in awake patients, has been shown to lower intubation rates and improve oxygenation. Strategies consistent with ARDSnet can be implemented in this patient population, with a goal tidal volume of 4-8 mL/kg of predicted body weight and targeted plateau pressures <30 cm H2O. Limited data support the use of neuromuscular blocking agents (NBMA), recruitment maneuvers, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation (ECMO). CONCLUSION This review presents a concise update of the resuscitation strategies and airway management techniques in patients with COVID-19 for emergency medicine clinicians.
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Affiliation(s)
- Summer Chavez
- The University of Texas at Houston Health Science Center, Department of Emergency Medicine, 6431 Fannin, 2nd Floor JJL, Houston, TX 77030, United States of America
| | - William J. Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | | | - Stephen Y. Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America,Corresponding author at: 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States of America
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25
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Abstract
During the early phase of the COVID-19 pandemic, many respiratory therapies were classified as aerosol-generating procedures. This categorization resulted in a broad range of clinical concerns and a shortage of essential medical resources for some patients. In the past 2 years, many studies have assessed the transmission risk posed by various respiratory care procedures. These studies are discussed in this narrative review, with recommendations for mitigating transmission risk based on the current evidence.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, Illinois
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26
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Katiyar SK, Gaur SN, Solanki RN, Sarangdhar N, Suri JC, Kumar R, Khilnani GC, Chaudhary D, Singla R, Koul PA, Mahashur AA, Ghoshal AG, Behera D, Christopher DJ, Talwar D, Ganguly D, Paramesh H, Gupta KB, Kumar T M, Motiani PD, Shankar PS, Chawla R, Guleria R, Jindal SK, Luhadia SK, Arora VK, Vijayan VK, Faye A, Jindal A, Murar AK, Jaiswal A, M A, Janmeja AK, Prajapat B, Ravindran C, Bhattacharyya D, D'Souza G, Sehgal IS, Samaria JK, Sarma J, Singh L, Sen MK, Bainara MK, Gupta M, Awad NT, Mishra N, Shah NN, Jain N, Mohapatra PR, Mrigpuri P, Tiwari P, Narasimhan R, Kumar RV, Prasad R, Swarnakar R, Chawla RK, Kumar R, Chakrabarti S, Katiyar S, Mittal S, Spalgais S, Saha S, Kant S, Singh VK, Hadda V, Kumar V, Singh V, Chopra V, B V. Indian Guidelines on Nebulization Therapy. Indian J Tuberc 2022; 69 Suppl 1:S1-S191. [PMID: 36372542 DOI: 10.1016/j.ijtb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 06/16/2023]
Abstract
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated.
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Affiliation(s)
- S K Katiyar
- Department of Tuberculosis & Respiratory Diseases, G.S.V.M. Medical College & C.S.J.M. University, Kanpur, Uttar Pradesh, India.
| | - S N Gaur
- Vallabhbhai Patel Chest Institute, University of Delhi, Respiratory Medicine, School of Medical Sciences and Research, Sharda University, Greater NOIDA, Uttar Pradesh, India
| | - R N Solanki
- Department of Tuberculosis & Chest Diseases, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Nikhil Sarangdhar
- Department of Pulmonary Medicine, D. Y. Patil School of Medicine, Navi Mumbai, Maharashtra, India
| | - J C Suri
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Raj Kumar
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, National Centre of Allergy, Asthma & Immunology; University of Delhi, Delhi, India
| | - G C Khilnani
- PSRI Institute of Pulmonary, Critical Care, & Sleep Medicine, PSRI Hospital, Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Dhruva Chaudhary
- Department of Pulmonary & Critical Care Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rupak Singla
- Department of Tuberculosis & Respiratory Diseases, National Institute of Tuberculosis & Respiratory Diseases (formerly L.R.S. Institute), Delhi, India
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India
| | - Ashok A Mahashur
- Department of Respiratory Medicine, P. D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - A G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - D Behera
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - D J Christopher
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Talwar
- Metro Centre for Respiratory Diseases, Noida, Uttar Pradesh, India
| | | | - H Paramesh
- Paediatric Pulmonologist & Environmentalist, Lakeside Hospital & Education Trust, Bengaluru, Karnataka, India
| | - K B Gupta
- Department of Tuberculosis & Respiratory Medicine, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences Rohtak, Haryana, India
| | - Mohan Kumar T
- Department of Pulmonary, Critical Care & Sleep Medicine, One Care Medical Centre, Coimbatore, Tamil Nadu, India
| | - P D Motiani
- Department of Pulmonary Diseases, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - P S Shankar
- SCEO, KBN Hospital, Kalaburagi, Karnataka, India
| | - Rajesh Chawla
- Respiratory and Critical Care Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Randeep Guleria
- All India Institute of Medical Sciences, Department of Pulmonary Medicine & Sleep Disorders, AIIMS, New Delhi, India
| | - S K Jindal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Luhadia
- Department of Tuberculosis and Respiratory Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - V K Arora
- Indian Journal of Tuberculosis, Santosh University, NCR Delhi, National Institute of TB & Respiratory Diseases Delhi, India; JIPMER, Puducherry, India
| | - V K Vijayan
- Vallabhbhai Patel Chest Institute, Department of Pulmonary Medicine, University of Delhi, Delhi, India
| | - Abhishek Faye
- Centre for Lung and Sleep Disorders, Nagpur, Maharashtra, India
| | | | - Amit K Murar
- Respiratory Medicine, Cronus Multi-Specialty Hospital, New Delhi, India
| | - Anand Jaiswal
- Respiratory & Sleep Medicine, Medanta Medicity, Gurugram, Haryana, India
| | - Arunachalam M
- All India Institute of Medical Sciences, New Delhi, India
| | - A K Janmeja
- Department of Respiratory Medicine, Government Medical College, Chandigarh, India
| | - Brijesh Prajapat
- Pulmonary and Critical Care Medicine, Yashoda Hospital and Research Centre, Ghaziabad, Uttar Pradesh, India
| | - C Ravindran
- Department of TB & Chest, Government Medical College, Kozhikode, Kerala, India
| | - Debajyoti Bhattacharyya
- Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, Army Hospital (Research & Referral), New Delhi, India
| | | | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - J K Samaria
- Centre for Research and Treatment of Allergy, Asthma & Bronchitis, Department of Chest Diseases, IMS, BHU, Varanasi, Uttar Pradesh, India
| | - Jogesh Sarma
- Department of Pulmonary Medicine, Gauhati Medical College and Hospital, Guwahati, Assam, India
| | - Lalit Singh
- Department of Respiratory Medicine, SRMS Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
| | - M K Sen
- Department of Respiratory Medicine, ESIC Medical College, NIT Faridabad, Haryana, India; Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Mahendra K Bainara
- Department of Pulmonary Medicine, R.N.T. Medical College, Udaipur, Rajasthan, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi PostGraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nilkanth T Awad
- Department of Pulmonary Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | - Narayan Mishra
- Department of Pulmonary Medicine, M.K.C.G. Medical College, Berhampur, Orissa, India
| | - Naveed N Shah
- Department of Pulmonary Medicine, Chest Diseases Hospital, Government Medical College, Srinagar, Jammu & Kashmir, India
| | - Neetu Jain
- Department of Pulmonary, Critical Care & Sleep Medicine, PSRI, New Delhi, India
| | - Prasanta R Mohapatra
- Department of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Orissa, India
| | - Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Pawan Tiwari
- School of Excellence in Pulmonary Medicine, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - R Narasimhan
- Department of EBUS and Bronchial Thermoplasty Services at Apollo Hospitals, Chennai, Tamil Nadu, India
| | - R Vijai Kumar
- Department of Pulmonary Medicine, MediCiti Medical College, Hyderabad, Telangana, India
| | - Rajendra Prasad
- Vallabhbhai Patel Chest Institute, University of Delhi and U.P. Rural Institute of Medical Sciences & Research, Safai, Uttar Pradesh, India
| | - Rajesh Swarnakar
- Department of Respiratory, Critical Care, Sleep Medicine and Interventional Pulmonology, Getwell Hospital & Research Institute, Nagpur, Maharashtra, India
| | - Rakesh K Chawla
- Department of, Respiratory Medicine, Critical Care, Sleep & Interventional Pulmonology, Saroj Super Speciality Hospital, Jaipur Golden Hospital, Rajiv Gandhi Cancer Hospital, Delhi, India
| | - Rohit Kumar
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - S Chakrabarti
- Department of Pulmonary, Critical Care & Sleep Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | | | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Surya Kant
- Department of Respiratory (Pulmonary) Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Centre for Visceral Mechanisms, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine & Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Kumar
- All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virendra Singh
- Mahavir Jaipuria Rajasthan Hospital, Jaipur, Rajasthan, India
| | - Vishal Chopra
- Department of Chest & Tuberculosis, Government Medical College, Patiala, Punjab, India
| | - Visweswaran B
- Interventional Pulmonology, Yashoda Hospitals, Hyderabad, Telangana, India
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27
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Oxygénothérapie à haut débit nasal dans l’insuffisance respiratoire aiguë hypoxémique. Rev Mal Respir 2022; 39:607-617. [DOI: 10.1016/j.rmr.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022]
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28
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Doubravská L, Htoutou Sedláková M, Fišerová K, Pudová V, Urbánek K, Petrželová J, Röderová M, Langová K, Mezerová K, Kučová P, Axmann K, Kolář M. Bacterial Resistance to Antibiotics and Clonal Spread in COVID-19-Positive Patients on a Tertiary Hospital Intensive Care Unit, Czech Republic. Antibiotics (Basel) 2022; 11:antibiotics11060783. [PMID: 35740188 PMCID: PMC9219711 DOI: 10.3390/antibiotics11060783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
This observational retrospective study aimed to analyze whether/how the spectrum of bacterial pathogens and their resistance to antibiotics changed during the worst part of the COVID-19 pandemic (1 November 2020 to 30 April 2021) among intensive care patients in University Hospital Olomouc, Czech Republic, as compared with the pre-pandemic period (1 November 2018 to 30 April 2019). A total of 789 clinically important bacterial isolates from 189 patients were cultured during the pre-COVID-19 period. The most frequent etiologic agents causing nosocomial infections were strains of Klebsiella pneumoniae (17%), Pseudomonas aeruginosa (11%), Escherichia coli (10%), coagulase-negative staphylococci (9%), Burkholderia multivorans (8%), Enterococcus faecium (6%), Enterococcus faecalis (5%), Proteus mirabilis (5%) and Staphylococcus aureus (5%). Over the comparable COVID-19 period, a total of 1500 bacterial isolates from 372 SARS-CoV-2-positive patients were assessed. While the percentage of etiological agents causing nosocomial infections increased in Enterococcus faecium (from 6% to 19%, p < 0.0001), Klebsiella variicola (from 1% to 6%, p = 0.0004) and Serratia marcescens (from 1% to 8%, p < 0.0001), there were significant decreases in Escherichia coli (from 10% to 3%, p < 0.0001), Proteus mirabilis (from 5% to 2%, p = 0.004) and Staphylococcus aureus (from 5% to 2%, p = 0.004). The study demonstrated that the changes in bacterial resistance to antibiotics are ambiguous. An increase in the frequency of ESBL-positive strains of some species (Serratia marcescens and Enterobacter cloacae) was confirmed; on the other hand, resistance decreased (Escherichia coli, Acinetobacter baumannii) or the proportion of resistant strains remained unchanged over both periods (Klebsiella pneumoniae, Enterococcus faecium). Changes in pathogen distribution and resistance were caused partly due to antibiotic selection pressure (cefotaxime consumption increased significantly in the COVID-19 period), but mainly due to clonal spread of identical bacterial isolates from patient to patient, which was confirmed by the pulse field gel electrophoresis methodology. In addition to the above shown results, the importance of infection prevention and control in healthcare facilities is discussed, not only for dealing with SARS-CoV-2 but also for limiting the spread of bacteria.
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Affiliation(s)
- Lenka Doubravská
- Department of Anesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (L.D.); (K.A.)
| | - Miroslava Htoutou Sedláková
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.F.); (J.P.); (P.K.)
- Correspondence: ; Tel.: +420-585-639-511
| | - Kateřina Fišerová
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.F.); (J.P.); (P.K.)
| | - Vendula Pudová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (V.P.); (M.R.); (K.M.); (M.K.)
| | - Karel Urbánek
- Department of Pharmacology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic;
| | - Jana Petrželová
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.F.); (J.P.); (P.K.)
| | - Magdalena Röderová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (V.P.); (M.R.); (K.M.); (M.K.)
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic;
| | - Kristýna Mezerová
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (V.P.); (M.R.); (K.M.); (M.K.)
| | - Pavla Kučová
- Department of Microbiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (K.F.); (J.P.); (P.K.)
| | - Karel Axmann
- Department of Anesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic; (L.D.); (K.A.)
| | - Milan Kolář
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic; (V.P.); (M.R.); (K.M.); (M.K.)
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García-Pereña L, Ramos Sesma V, Tornero Divieso ML, Lluna Carrascosa A, Velasco Fuentes S, Parra-Ruiz J. Benefits of early use of high-flow-nasal-cannula (HFNC) in patients with COVID-19 associated pneumonia. MEDICINA CLÍNICA (ENGLISH EDITION) 2022; 158:540-542. [PMID: 35634247 PMCID: PMC9130639 DOI: 10.1016/j.medcle.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | - Jorge Parra-Ruiz
- Servicio de Medicina Interna, Hospital HLA Inmaculada, Granada, Spain
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30
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Ma XH, An MM, Yin F, Zhang J, Peng MY, Guan H, Gong P. Factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19: a retrospective case series. J Int Med Res 2022; 50:3000605221103525. [PMID: 35638595 PMCID: PMC9160912 DOI: 10.1177/03000605221103525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To identify factors associated with high-flow nasal cannula (HFNC) therapy failure in patients with severe COVID-19. Methods We retrospectively examined clinical and laboratory data upon admission, treatments, and outcomes of patients with severe COVID-19. Sequential Organ Failure Assessment (SOFA) scores were also calculated. Results Of 54 patients with severe COVID-19, HFNC therapy was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC therapy failure was more common in patients aged ≥60 years and in men. Compared with patients with successful HFNC therapy, patients with HFNC therapy failure had higher percentages of fatigue, anorexia, and cardiovascular disease; a longer time from symptom onset to diagnosis; higher SOFA scores; a higher body temperature, respiratory rate, and heart rate; more complications, including acute respiratory distress syndrome, septic shock, myocardial damage, and acute kidney injury; a higher C-reactive protein concentration, neutrophil count, and prothrombin time; and a lower arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2). However, male sex, a low PaO2/FiO2, and a high SOFA score were the only independent factors significantly associated with HFNC therapy failure. Conclusions Male sex, a low PaO2/FiO2, and a high SOFA score were independently associated with HFNC therapy failure in patients with severe COVID-19.
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Affiliation(s)
- Xiao-Huan Ma
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.,Intensive Care Unit, The Second People's Hospital of Dalian, Dalian, Liaoning, China
| | - Meng-Meng An
- Intensive Care Unit, Affiliated Dalian Friendship Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Fang Yin
- Neurosurgical Intensive Care Unit, First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jie Zhang
- Department of Gynecology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Meng-Yun Peng
- College of Nursing, Dalian Medical University, Liaoning, China
| | - Hong Guan
- Department of Nursing, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Ping Gong
- Department of Emergency, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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31
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Low Oxygen Saturation of COVID-19 in Patient Case Fatalities, Limpopo Province, South Africa. JOURNAL OF RESPIRATION 2022. [DOI: 10.3390/jor2020006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
On 1 August 2020, South Africa’s Minister of Health announced that more than half of a million coronavirus cases were confirmed in the country. South Africa was by far the hardest-hit country in Africa, accounting for half of all infections reported across the continent. The prevalence of underlying conditions such as fever and blood oxygen saturation (SpO2) has been known known to be a significant determinant in the hospitalisation of COVID-19 patients. Low oxygen saturation on admission was reported as a strong predictor of in-hospital mortality in COVID-19 patients. The study sought to assess the association between body temperature and other clinical risk factors with low SpO2 among COVID-19 inpatient case fatalities. A quantitative retrospective study was carried out in Limpopo Province, employing secondary data from the Limpopo Department of Health (LDoH) on COVID-19 inpatients case fatalities across all districts in the province. The chi-square test and Pearson’s correlation coefficient were used to assess the relationship between body temperature and clinical risk factors with SpO2 levels. The findings of this paper indicated that age (older age), chills, sore throat, anosmia, dysgeusia, myalgia/body aches, diarrhoea and HIV/AIDS were associated with low SpO2 in-hospital mortality in COVID-19 patients. Nasal prongs and a face mask with a reservoir for respiratory support cannula were commonly used patient interfaces to provide supplemental oxygen, with the use of only a high-flow nasal cannula (HFNC) being minimal (7%). The majority of COVID-19 inpatient fatalities had normal body temperature (<38 °C) and SpO2, with no correlation between the two variables. Considering temperature screening as a possible strategy to combat the spread of COVID-19 or suspicious COVID-19 cases appeared, then, to be a pointless exercise. This study aimed to recommend new clinical criteria for detecting COVID-19 cases.
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Schwartz BC, Jayaraman D, Yang SS, Wong EG, Lipes J, Dial S. High-flow nasal oxygen as first-line therapy for COVID-19-associated hypoxemic respiratory failure: a single-centre historical cohort study. Can J Anaesth 2022; 69:582-590. [PMID: 35211876 PMCID: PMC8870079 DOI: 10.1007/s12630-022-02218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The optimal noninvasive modality for oxygenation support in COVID-19-associated hypoxemic respiratory failure and its association with healthcare worker infection remain uncertain. We report here our experience using high-flow nasal oxygen (HFNO) as the primary support mode for patients with COVID-19 in our institution. METHODS We conducted a single-centre historical cohort study of all COVID-19 patients treated with HFNO for at least two hours in our university-affiliated and intensivist-staffed intensive care unit (Jewish General Hospital, Montreal, QC, Canada) between 27 August 2020 and 30 April 2021. We report their clinical characteristics and outcomes. Healthcare workers in our unit cared for these patients in single negative pressure rooms wearing KN95 or fit-tested N95 masks; they underwent mandatory symptomatic screening for COVID-19 infection, as well as a period of asymptomatic screening. RESULTS One hundred and forty-two patients were analysed, with a median [interquartile range (IQR)] age of 66 [59-73] yr; 71% were male. Patients had a median [IQR] Sequential Organ Failure Assessment Score of 3 [2-3], median [IQR] oxygen saturation by pulse oximetry/fraction of inspired oxygen ratio of 120 [94-164], and a median [IQR] 4C score (a COVID-19-specific mortality score) of 12 [10-14]. Endotracheal intubation occurred in 48/142 (34%) patients, and overall hospital mortality was 16%. Barotrauma occurred in 21/142 (15%) patients. Among 27 symptomatic and 139 asymptomatic screening tests, there were no cases of HFNO-related COVID-19 transmission to healthcare workers. CONCLUSION Our experience indicates that HFNO is an effective first-line therapy for hypoxemic respiratory failure in COVID-19 patients, and can be safely used without significant discernable infection risk to healthcare workers.
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Affiliation(s)
- Blair Carl Schwartz
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
| | - Dev Jayaraman
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Stephen Su Yang
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Evan G Wong
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Jed Lipes
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Sandra Dial
- Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
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Onorati I, Bonnet N, Radu DM, Freynet O, Guiraudet P, Kambouchner M, Uzunhan Y, Zogheib E, Martinod E. Case Report: Laryngotracheal Post-Intubation/Tracheostomy Stenosis in COVID-19 Patients. Front Surg 2022; 9:874077. [PMID: 35548193 PMCID: PMC9082634 DOI: 10.3389/fsurg.2022.874077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The novel Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has spread rapidly to become a major global public health emergency since March 2020. Laryngotracheal stenosis (LTS) has been observed more frequently since the onset of the COVID-19 pandemic. Methods All patients referred to our 24/7 Airway Diseases Center for laryngotracheal post-intubation/tracheostomy stenosis from May 2020 to May 2021were evaluated retrospectively. Patient data on comorbidities, diagnosis, type of procedures, lengths of ICU stay and invasive mechanical ventilation, medical treatment, and the severity of illness were recorded. Results This case series included nine patients (five women and four men), with a mean age of 52.9 years, most with a BMI >30, all with a severe illness revealed by the Simplified Acute Physiology Score (SAPS) II >31. From May 2020 to May 2021, 21 procedures were performed on seven patients, consisting of bronchoscopic rigid interventions, T-tube Montgomery tracheostomy, and one cricotracheal resection with end-to-end anastomosis. Histologic examination of tracheal biopsies showed an inflammatory state of the airway mucosa. Two patients only had medical therapy. Discussion and Conclusions Pneumonia caused by SARSCoV-2 can lead to severe acute respiratory distress syndrome (ARDS) requiring invasive mechanical ventilation. The time of intubation, the drugs used, the prone position, comorbidities (diabetes, obesity), and the inflammatory state of the upper airways linked to the viral infection, predispose to an increased tendency to stenosis and its recurrence. A conservative approach with medical and endoscopic treatment should be preferred in case of persistence of local airways inflammation. Further studies with a larger sample of patients will help to a better understanding of the disease, reduce the prevalence, and improve its treatment.
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Affiliation(s)
- Ilaria Onorati
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
- *Correspondence: Ilaria Onorati
| | - Nicolas Bonnet
- Department of Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Dana Mihaela Radu
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Olivia Freynet
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Patrice Guiraudet
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Yurdagul Uzunhan
- Department of Pulmonology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Elie Zogheib
- Department of Anesthesiology, Assistance Publique Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
| | - Emmanuel Martinod
- Department of Thoracic and Vascular Surgery, Assistance Publique-Hôpitaux de Paris, UFR de Santé Médecine Biologie Humaine, Université Sorbonne Paris Nord, Bobigny, France
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Gamal M, Kamal MA, Abuelazm M, Yousaf A, Abdelazeem B. Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography. Proc AMIA Symp 2022; 35:485-491. [DOI: 10.1080/08998280.2022.2062554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | | | | | - Amman Yousaf
- McLaren Health Care, Flint, Michigan
- Michigan State University, East Lansing, Michigan
| | - Basel Abdelazeem
- McLaren Health Care, Flint, Michigan
- Michigan State University, East Lansing, Michigan
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35
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Brioni M, Meli A, Grasselli G. Mechanical Ventilation for COVID-19 Patients. Semin Respir Crit Care Med 2022; 43:405-416. [PMID: 35439831 DOI: 10.1055/s-0042-1744305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Non-invasive ventilation (NIV) or invasive mechanical ventilation (MV) is frequently needed in patients with acute hypoxemic respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While NIV can be delivered in hospital wards and nonintensive care environments, intubated patients require intensive care unit (ICU) admission and support. Thus, the lack of ICU beds generated by the pandemic has often forced the use of NIV in severely hypoxemic patients treated outside the ICU. In this context, awake prone positioning has been widely adopted to ameliorate oxygenation during noninvasive respiratory support. Still, the incidence of NIV failure and the role of patient self-induced lung injury on hospital outcomes of COVID-19 subjects need to be elucidated. On the other hand, endotracheal intubation is indicated when gas exchange deterioration, muscular exhaustion, and/or neurological impairment ensue. Yet, the best timing for intubation in COVID-19 is still widely debated, as it is the safest use of neuromuscular blocking agents. Not differently from other types of acute respiratory distress syndrome, the aim of MV during COVID-19 is to provide adequate gas exchange while avoiding ventilator-induced lung injury. At the same time, the use of rescue therapies is advocated when standard care is unable to guarantee sufficient organ support. Nevertheless, the general shortage of health care resources experienced during SARS-CoV-2 pandemic might affect the utilization of high-cost, highly specialized, and long-term supports. In this article, we describe the state-of-the-art of NIV and MV setting and their usage for acute hypoxemic respiratory failure of COVID-19 patients.
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Affiliation(s)
- Matteo Brioni
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Meli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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36
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Frat JP, Le Pape S, Coudroy R, Thille AW. Noninvasive Oxygenation in Patients with Acute Respiratory Failure: Current Perspectives. Int J Gen Med 2022; 15:3121-3132. [PMID: 35418775 PMCID: PMC9000535 DOI: 10.2147/ijgm.s294906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/22/2022] [Indexed: 01/16/2023] Open
Abstract
Purpose of Review High-flow nasal oxygen and noninvasive ventilation are two alternative strategies to standard oxygen in the management of acute respiratory failure. Discussion Although high-flow nasal oxygen has gained major popularity in ICUs due to its simplicity of application, good comfort for patients, efficiency in improving oxygenation and promising results in patients with acute hypoxemic respiratory failure, further large clinical trials are needed to confirm its superiority over standard oxygen. Non-invasive ventilation may have deleterious effects, especially in patients exerting strong inspiratory efforts, and no current recommendations support its use in this setting. Protective non-invasive ventilation using higher levels of positive-end expiratory pressure, more prolonged sessions and other interfaces such as the helmet may have beneficial physiological effects leading to it being proposed as alternative to high-flow nasal oxygen in acute hypoxemic respiratory failure. By contrast, non-invasive ventilation is the first-line strategy of oxygenation in patients with acute exacerbation of chronic lung disease, while high-flow nasal oxygen could be an alternative to non-invasive ventilation after partial reversal of respiratory acidosis. Questions remain about the target populations and non-invasive oxygen strategy representing the best alternative to standard oxygen in acute hypoxemic respiratory failure. As concerns acute on-chronic-respiratory failure, the place of high-flow nasal oxygen remains to be evaluated.
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Affiliation(s)
- Jean-Pierre Frat
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- Centre d’Investigation Clinique 1402 ALIVE, INSERM, Université de Poitiers, Poitiers, France
| | - Sylvain Le Pape
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Rémi Coudroy
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- Centre d’Investigation Clinique 1402 ALIVE, INSERM, Université de Poitiers, Poitiers, France
| | - Arnaud W Thille
- Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- Centre d’Investigation Clinique 1402 ALIVE, INSERM, Université de Poitiers, Poitiers, France
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37
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The Aerosol-Generating Effect Among Noninvasive Positive Pressure Ventilation, High-Flow Nasal Cannula, Nonrebreather Mask, Nasal Cannula, and Ventilator-Assisted Preoxygenation. Ann Emerg Med 2022; 80:22-34. [DOI: 10.1016/j.annemergmed.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
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Cosentino F, Moscatt V, Marino A, Pampaloni A, Scuderi D, Ceccarelli M, Benanti F, Gussio M, Larocca L, Boscia V, Vinci G, Zagami A, Onorante A, Lupo G, Torrisi S, Grasso S, Bruno R, Iacobello C, Bonfante S, Guarneri L, Cascio A, Franco A, Del Vecchio R, Di Rosolini M, Pulvirenti A, Larnè D, Nunnari G, Celesia B, Cacopardo B. Clinical characteristics and predictors of death among hospitalized patients infected with SARS‑CoV‑2 in Sicily, Italy: A retrospective observational study. Biomed Rep 2022; 16:34. [PMID: 35386106 PMCID: PMC8972844 DOI: 10.3892/br.2022.1517] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Federica Cosentino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Vittoria Moscatt
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Alessio Pampaloni
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Daniele Scuderi
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Manuela Ceccarelli
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Francesco Benanti
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Maria Gussio
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Licia Larocca
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Vincenzo Boscia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Giovanni Vinci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Aldo Zagami
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Anna Onorante
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Gaetano Lupo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Salvatore Torrisi
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Silvana Grasso
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Roberto Bruno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Carmelo Iacobello
- Infectious Disease Unit, Cannizzaro Hospital, I-95126 Catania, Italy
| | - Salvatore Bonfante
- Infectious Diseases Unit, Gravina Hospital, I-95041 Caltagirone, Catania, Italy
| | - Luigi Guarneri
- Infectious Diseases Unit, Enna Hospital, I-94100 Enna, Italy
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, I-90127 Palermo, Italy
| | - Antonella Franco
- Infectious Diseases Unit, Siracusa Hospital, I-96100 Siracusa, Italy
| | | | - Maria Di Rosolini
- Infectious and Tropical Diseases Unit, Modica Hospital, I-97015 Ragusa, Italy
| | - Alfredo Pulvirenti
- Bioinformatics Section, Department of Clinical and Experimental Medicine, University of Catania, I-95125 Catania, Italy
| | - Damiano Larnè
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-98124 Messina, Italy
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, I-98124 Messina, Italy
| | - Benedetto Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
| | - Bruno Cacopardo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Nesima Hospital, University of Catania, I-95122 Catania, Italy
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Chandrasekaran K, Monikandan Shaji A. “The role of a negative pressure ventilator coupled with oxygen helmet against COVID-19: a review”. RESEARCH ON BIOMEDICAL ENGINEERING 2022. [PMCID: PMC8060160 DOI: 10.1007/s42600-021-00149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background The coronavirus (SARS-COV-2) pandemic has provoked the global healthcare industry by potentially affecting more than 20 14 million people across the globe, causing lasting damage to the lungs, notably pneumonia, ARDS (acute respiratory distress 15 syndrome), and sepsis with the rapid spread of infection. To aid the functioning of the lungs and to maintain the blood oxygen 16 saturation (SpO2) in coronavirus patients, ventilator assistance is required. Materials and methods The main purpose of this article is to outline the need 17 for the introduction of a non-invasive negative pressure ventilator (NINPV) as a promising alternative to positive pressure 18 ventilator (PPV) by elucidating the cons of non-invasive ventilators in clinical conditions like ARDS. Another motive is to 19 profoundly diminish the rate of infection spread by the employment of oxygen helmets, instead of endotracheal intubation in 20 invasive positive pressure ventilator (IPPV) or non-invasive positive pressure ventilator (NIPPV) like face masks and high-flow 21 nasal cannula (HFNC). Result and conclusion The integration of oxygen helmet with NPV would result in a number of notable facets including the 22 degree of comfort delivered to patients who are exposed to various ventilator-induced lung injuries (VILI) in the forms of 23 atelectasis, barotrauma, etc. Likewise, preventing the aerosol-generating procedures (AGP) diminishes the rate of nosocomial 24 infections and providing a better environment to both the patients and the healthcare professionals.
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Affiliation(s)
| | - Aadharsha Monikandan Shaji
- Department of Biomedical Engineering, Sri Shakthi Institute of Engineering and Technology, Coimbatore, Tamil Nadu India
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Ferré A, Marquion F, Delord M, Gros A, Lacave G, Laurent V, Merceron S, Paul M, Simon C, Troché G, Charbonnel C, Marque-Juillet S, Bruneel F, Legriel S. Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study. Ann Intensive Care 2022; 12:10. [PMID: 35133543 PMCID: PMC8821831 DOI: 10.1186/s13613-022-00981-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. Results We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11–32] vs. 21 [13–37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44). Conclusions In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00981-2.
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Affiliation(s)
- Alexis Ferré
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.
| | - Fabien Marquion
- Department of Anesthesiology, Versailles Hospital, Le Chesnay, France
| | - Marc Delord
- Clinical Research Center, Versailles Hospital, Le Chesnay, France.,Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Antoine Gros
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Guillaume Lacave
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Virginie Laurent
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Sybille Merceron
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Marine Paul
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Christelle Simon
- Department of Anesthesiology, Versailles Hospital, Le Chesnay, France
| | - Gilles Troché
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | | | | | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Stéphane Legriel
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.,University Paris-Saclay, UVSQ, INSERM, CESP, "PsyDev" Team, Villejuif, France
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Hosoda T, Hamada S, Numata K, Saito Y, Yamazaki S, Minoura A, Sakamoto M, Fujitani S. Intensive care burden of COVID-19 in tertiary care hospitals during the first year of outbreak in Kawasaki City, Japan: A retrospective cohort study. J Infect Chemother 2022; 28:678-683. [PMID: 35177351 PMCID: PMC8825303 DOI: 10.1016/j.jiac.2022.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/10/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022]
Abstract
Introduction This study aimed to describe the changes in the intensive care burden of coronavirus disease 2019 (COVID-19) during the first year of outbreak in Japan. Methods This retrospective cohort study included COVID-19 patients who received mechanical ventilation (MV) support in two designated hospitals for critical patients in Kawasaki City. We compared the lengths of MV and stay in the intensive care unit (ICU) or high care unit (HCU) according to the three epidemic waves. We calculated in-hospital mortality rates in patients with or without MV. Results The median age of the sample was 65.0 years, and 22.7% were women. There were 37, 29, and 62 patients in the first (W1), second (W2), and third waves (W3), respectively. Systemic steroids, remdesivir, and prone positioning were more frequent in W2 and W3. The median length of MV decreased from 18.0 days in W1 to 13.0 days in W3 (P = 0.019), and that of ICU/HCU stay decreased from 22.0 days in W1 to 15.5 days in W3 (P = 0.027). The peak daily number of patients receiving MV support was higher at 18 patients in W1, compared to 8 and 15 patients in W2 and W3, respectively. The mortality rate was 23.4%, which did not significantly change (P = 0.467). Conclusions The lengths of MV and ICU/HCU stay per patient decreased over time. Despite an increase in the number of COVID-19 patients who received MV in W3, this study may indicate that the intensive care burden during the study period did not substantially increase.
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Crimi C, Pierucci P, Renda T, Pisani L, Carlucci A. High-Flow Nasal Cannula and COVID-19: A Clinical Review. Respir Care 2022; 67:227-240. [PMID: 34521762 PMCID: PMC9993935 DOI: 10.4187/respcare.09056] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, noninvasive respiratory support has played a central role in managing patients affected by moderate-to-severe acute hypoxemic respiratory failure, despite inadequate scientific evidence to support its usage. High-flow nasal cannula (HFNC) treatment has gained popularity because of its effectiveness in delivering a high fraction of humidified oxygen, which improves ventilatory efficiency and the respiratory pattern, as well as its reported high tolerability, ease of use, and application outside of ICUs. Nevertheless, the risk of infection transmission to health-care workers has raised some concerns about its use in the first wave of the pandemic outbreak, with controversial recommendations provided by different scientific societies. This narrative review provides an overview of the recent evidence on the physiologic rationale, risks, and benefits of using HFNC instead of conventional oxygen therapy and other types of noninvasive respiratory support devices, such as continuous positive airway pressure and noninvasive ventilation in patients affected by COVID-19 pneumonia with associated acute hypoxemic respiratory failure. It also summarizes the available evidence with regard to the clinical use of HFNC during the current pandemic and its reported outcomes, and highlights the risks of bioaerosol dispersion associated with HFNC use.
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Affiliation(s)
- Claudia Crimi
- Respiratory Medicine Unit, "Policlinico-Vittorio Emanuele-San Marco," University Hospital, Catania, Italy.
| | - Paola Pierucci
- Respiratory Medicine Unit, Policlinico "Aldo Moro" University Hospital, Bari, Italy
| | - Teresa Renda
- Respiratory and Critical Care Unit, Cardio-thoracic and Vascular Department, Careggi Teaching Hospital, Florence, Italy
| | - Lara Pisani
- Respiratory and Critical Care Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi, Bologna, Italy
- Department of Clinical, Integrated and Experimental Medicine, Alma Mater Studiorum University, Bologna, Italy
| | - Annalisa Carlucci
- Department of Medicine and Surgery, Università Insubria, Varese-Como, Italy
- Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy
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Kerai S, Singh R, Saxena KN, Desai SD, Bhalotra AR. A Retrospective Study on Experience of High-flow Nasal Cannula Oxygen in Critically Ill COVID-19 Adult Patients Admitted to Intensive Care Unit. Indian J Crit Care Med 2022; 26:62-66. [PMID: 35110846 PMCID: PMC8783255 DOI: 10.5005/jp-journals-10071-24097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Sukhyanti Kerai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Rahil Singh
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
- Rahil Singh, Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India, Phone: +91 9810719025, e-mail:
| | - Kirti N Saxena
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Suraj D Desai
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Anju R Bhalotra
- Department of Anaesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
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Sullivan ZP, Zazzeron L, Berra L, Hess DR, Bittner EA, Chang MG. Noninvasive respiratory support for COVID-19 patients: when, for whom, and how? J Intensive Care 2022; 10:3. [PMID: 35033204 PMCID: PMC8760575 DOI: 10.1186/s40560-021-00593-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/26/2021] [Indexed: 12/14/2022] Open
Abstract
The significant mortality rate and prolonged ventilator days associated with invasive mechanical ventilation (IMV) in patients with severe COVID-19 have incited a debate surrounding the use of noninvasive respiratory support (NIRS) (i.e., HFNC, CPAP, NIV) as a potential treatment strategy. Central to this debate is the role of NIRS in preventing intubation in patients with mild respiratory disease and the potential beneficial effects on both patient outcome and resource utilization. However, there remains valid concern that use of NIRS may prolong time to intubation and lung protective ventilation in patients with more advanced disease, thereby worsening respiratory mechanics via self-inflicted lung injury. In addition, the risk of aerosolization with the use of NIRS has the potential to increase healthcare worker (HCW) exposure to the virus. We review the existing literature with a focus on rationale, patient selection and outcomes associated with the use of NIRS in COVID-19 and prior pandemics, as well as in patients with acute respiratory failure due to different etiologies (i.e., COPD, cardiogenic pulmonary edema, etc.) to understand the potential role of NIRS in COVID-19 patients. Based on this analysis we suggest an algorithm for NIRS in COVID-19 patients which includes indications and contraindications for use, monitoring recommendations, systems-based practices to reduce HCW exposure, and predictors of NIRS failure. We also discuss future research priorities for addressing unanswered questions regarding NIRS use in COVID-19 with the goal of improving patient outcomes.
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Affiliation(s)
- Zachary P Sullivan
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Luca Zazzeron
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Dean R Hess
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - Marvin G Chang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, MA, Boston, USA.
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Xu DY, Dai B, Tan W, Zhao HW, Wang W, Kang J. Effectiveness of the use of a high-flow nasal cannula to treat COVID-19 patients and risk factors for failure: a meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221091931. [PMID: 35467449 PMCID: PMC9047804 DOI: 10.1177/17534666221091931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread globally, and many patients
with severe cases have received oxygen therapy through a high-flow nasal
cannula (HFNC). Objectives: We assessed the efficacy of HFNC for treating patients with COVID-19 and risk
factors for HFNC failure. Methods: We searched PubMed, Embase, and the Cochrane Central Register of randomized
controlled trials (RCTs) and observational studies of HFNC in patients with
COVID-19 published in English from January 1st, 2020 to August 15th, 2021.
The primary aim was to assess intubation, mortality, and failure rates in
COVID-19 patients supported by HFNC. Secondary aims were to compare HFNC
success and failure groups and to describe the risk factors for HFNC
failure. Results: A total of 25 studies fulfilled selection criteria and included 2851
patients. The intubation, mortality, and failure rates were 0.44 (95%
confidence interval (CI): 0.38–0.51, I2 = 84%), 0.23 (95% CI:
0.19–0.29, I2 = 88%), and 0.47 (95% CI: 0.42–0.51,
I2 = 56%), respectively. Compared to the success group, age, body
mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute
Physiology and Chronic Health Evaluation (APACHE) II score, D-dimer,
lactate, heart rate, and respiratory rate were higher and PaO2,
PaO2/FiO2, ROX index (the ratio of
SpO2/FiO2 to respiratory rate), ROX index after
the initiation of HFNC, and duration of HFNC were lower in the failure group
(all Ps < 0.05). There were also more smokers and more comorbidities in
the failure group (all Ps < 0.05). Pooled odds ratios (ORs) revealed that
older age (OR: 1.04, 95% CI: 1.01–1.07, P = 0.02, I2 = 88%), a
higher white blood cell (WBC) count (OR: 1.06, 95% CI: 1.01–1.12, P = 0.02,
I2 = 0%), a higher heart rate (OR: 1.42, 95% CI: 1.15–1.76,
P < 0.01, I2 = 0%), and a lower ROX index(OR: 0.61, 95% CI:
0.39–0.95, P = 0.03, I2 = 93%) after the initiation of HFNC were
all significant risk factors for HFNC failure. Conclusions: HFNC is an effective way of providing respiratory support in the treatment of
COVID-19 patients. Older age, a higher WBC count, a higher heart rate, and a
lower ROX index after the initiation of HFNC are associated with an
increased risk of HFNC failure.
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Affiliation(s)
- Dong-Yang Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bing Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, 110001 China
| | - Wei Tan
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, China
| | - Hong-Wen Zhao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
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Arnaud E. Feedback of inter-hospital transfer of patients under high-flow nasal cannula oxygen therapy. World J Emerg Med 2022; 13:219-221. [DOI: 10.5847/wjem.j.1920-8642.2022.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/02/2022] [Indexed: 11/19/2022] Open
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P. Abhilash K, David S, St Joseph E, Peter J. Acute management of COVID-19 in the emergency department: An evidence-based review. J Family Med Prim Care 2022; 11:424-433. [PMID: 35360783 PMCID: PMC8963605 DOI: 10.4103/jfmpc.jfmpc_1309_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease (COVID-19) has been relentlessly battering the world wave after wave in different countries at different rates and times. Emergency departments (EDs) around the globe have had to constantly adapt to this ever-changing influx of information and recommendations by various national and international health agencies. This review compiles the available evidence on the guidelines for triaging, evaluation, and management of critically ill patients with COVID-19 presenting to the ED and in need of emergency resuscitation. The quintessential components of resuscitation focus on airway, breathing, and circulation with good supportive care as the cornerstone of acute management of critically ill COVID-19 patients. Irrational investigations and therapeutics must be avoided during these times of medical uncertainty and antibiotic stewardship should be diligently followed.
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Troiano NH, Richter A, King C. Acute Respiratory Failure and Mechanical Ventilation in Women With COVID-19 During Pregnancy: Best Clinical Practices. J Perinat Neonatal Nurs 2022; 36:27-36. [PMID: 35089174 DOI: 10.1097/jpn.0000000000000621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Symptomatic pregnant women with coronavirus disease-2019 (COVID-19) are at increased risk of severe disease and death compared with symptomatic nonpregnant females of reproductive age. Among those who become critically ill, profound acute hypoxemic respiratory failure is the dominant finding. Significant morbidity and mortality from COVID-19 are largely due to acute viral pneumonia that evolves to acute respiratory distress syndrome. Admission of these patients with critical disease to an intensive care unit and initiation of invasive mechanical ventilation may be indicated. Effective ventilatory support can be challenging in the COVID-19 patient population, even more so when the need occurs in a woman during pregnancy. Key respiratory changes during pregnancy are reviewed. Principles related to maternal-fetal oxygen transport, assessment of ventilation and oxygenation status, and oxygenation goals are also reviewed. Selected concepts related to mechanical ventilatory support for the woman with COVID-19 and acute respiratory failure during pregnancy are presented including indications for ventilatory support, noninvasive support, and invasive ventilator management. Challenges in providing care to this patient population are identified as well as strategies to address them going forward.
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Affiliation(s)
- Nan H Troiano
- Women's & Infants' Services (Mss Troiano and King) and Labor and Delivery (Ms Richter), Adventist HealthCare Shady Grove Medical Center, Rockville, Maryland
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Strand-Amundsen R, Tronstad C, Elvebakk O, Martinsen T, Dybwad M, Lingaas E, Tønnessen TI. Quantification of aerosol dispersal from suspected aerosol-generating procedures. ERJ Open Res 2021; 7:00206-2021. [PMID: 34877350 PMCID: PMC8474485 DOI: 10.1183/23120541.00206-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Oxygen-delivering modalities like humidified high-flow nasal cannula (HFNC) and noninvasive positive-pressure ventilation (NIV) are suspected of generating aerosols that may contribute to transmission of disease such as coronavirus disease 2019. We sought to assess if these modalities lead to increased aerosol dispersal compared to the use of non-humidified low-flow nasal cannula oxygen treatment (LFNC). Methods Aerosol dispersal from 20 healthy volunteers using HFNC, LFNC and NIV oxygen treatment was measured in a controlled chamber. We investigated effects related to coughing and using a surgical face mask in combination with the oxygen delivering modalities. An aerodynamic particle sizer measured aerosol particles (APS3321, 0.3–20 µm) directly in front of the subjects, while a mesh of smaller particle sensors (SPS30, 0.3–10 µm) was distributed in the test chamber. Results Non-productive coughing led to significant increases in particle dispersal close to the face when using LFNC and HFNC but not when using NIV. HFNC or NIV did not lead to a statistically significant increase in aerosol dispersal compared to LFNC. With non-productive cough in a room without air changes, there was a significant drop in particle levels between 100 cm and 180 cm from the subjects. Conclusions Our results indicate that using HFNC and NIV does not lead to increased aerosol dispersal compared to low-flow oxygen treatment, except in rare cases. For a subject with non-productive cough, NIV with double-limb circuit and non-vented mask may be a favourable choice to reduce the risk for aerosol spread. High-flow nasal cannula or NIV oxygen treatment does not lead to an increase in aerosol dispersal compared to the use of low-flow nasal cannula oxygen. For a coughing patient, using dual-limb NIV may reduce the risk of aerosol spread.https://bit.ly/3AnoyJu
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Affiliation(s)
| | - Christian Tronstad
- Dept of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Ole Elvebakk
- Dept of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Tormod Martinsen
- Dept of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Marius Dybwad
- Norwegian Defence Research Establishment (FFI), Kjeller, Norway
| | - Egil Lingaas
- Dept of Infection Prevention, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Tor Inge Tønnessen
- Dept of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Berguigua H, Iche L, Roche P, Aubert C, Blondé R, Legrand A, Puech B, Combe C, Vidal C, Caron M, Jaffar-Bandjee MC, Caralp C, Oulehri N, Kerambrun H, Allyn J, Boué Y, Allou N. Emergency air evacuation of patients with acute respiratory failure due to SARS-CoV-2 from Mayotte to Reunion Island. Medicine (Baltimore) 2021; 100:e27881. [PMID: 35049190 PMCID: PMC9191376 DOI: 10.1097/md.0000000000027881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Abstract
In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46-65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO2/FiO2 ratio was lower on ICU admission (140 [102-192] mmHg) than on departure (165 [150-200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.
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Affiliation(s)
- Hamza Berguigua
- Department of Emergency, Center Hospitalier Universitaire Felix Guyon, Saint Denis, France
| | - Ludovic Iche
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Philippe Roche
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Cyril Aubert
- Department of Emergency, Center Hospitalier Universitaire Felix Guyon, Saint Denis, France
| | - Renaud Blondé
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Antoine Legrand
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Bérénice Puech
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Chloé Combe
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Charles Vidal
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | - Margot Caron
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
| | | | - Christophe Caralp
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Nora Oulehri
- Department of Emergency, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Hugo Kerambrun
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Jérôme Allyn
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
- Département d’Informatique Clinique, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
| | - Yvonnick Boué
- Réanimation Polyvalente, Center Hospitalier de Mayotte, Mamoudzou, France
| | - Nicolas Allou
- Réanimation polyvalente, Center Hospitalier Universitaire Felix Guyon Allée des Topazes Saint Denis, France
- Département d’Informatique Clinique, Centre Hospitalier Universitaire Felix Guyon Allée des Topazes, Saint Denis, France
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