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Luján M, Cinesi Gómez C, Peñuelas O, Ferrando C, Heili-Frades SB, Carratalá Perales JM, Mas A, Sayas Catalán J, Mediano O, Roca O, García Fernández J, González Varela A, Sempere Montes G, Rialp Cervera G, Hernández G, Millán T, Ferrer Monreal M, Egea Santaolalla C. Multidisciplinary Consensus on the Management of Non-Invasive Respiratory Support in the COVID-19 Patient. Arch Bronconeumol 2024; 60:285-295. [PMID: 38521646 DOI: 10.1016/j.arbres.2024.02.017] [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: 02/19/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
Acute respiratory failure due to COVID-19 pneumonia often requires a comprehensive approach that includes non-pharmacological strategies such as non-invasive support (including positive pressure modes, high flow therapy or awake proning) in addition to oxygen therapy, with the primary goal of avoiding endotracheal intubation. Clinical issues such as determining the optimal time to initiate non-invasive support, choosing the most appropriate modality (based not only on the acute clinical picture but also on comorbidities), establishing criteria for recognition of treatment failure and strategies to follow in this setting (including palliative care), or implementing de-escalation procedures when improvement occurs are of paramount importance in the ongoing management of severe COVID-19 cases. Organizational issues, such as the most appropriate setting for management and monitoring of the severe COVID-19 patient or protective measures to prevent virus spread to healthcare workers in the presence of aerosol-generating procedures, should also be considered. While many early clinical guidelines during the pandemic were based on previous experience with acute respiratory distress syndrome, the landscape has evolved since then. Today, we have a wealth of high-quality studies that support evidence-based recommendations to address these complex issues. This document, the result of a collaborative effort between four leading scientific societies (SEDAR, SEMES, SEMICYUC, SEPAR), draws on the experience of 25 experts in the field to synthesize knowledge to address pertinent clinical questions and refine the approach to patient care in the face of the challenges posed by severe COVID-19 infection.
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Affiliation(s)
- Manel Luján
- Servei de Pneumologia, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Oscar Peñuelas
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servicio de Medicina Intensiva Hospital Universitario de Getafe, Madrid, Spain
| | - Carlos Ferrando
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Department of Anesthesia and Critical Care, Hospital Clínic, Institut D'investigació August Pi i Sunyer, Barcelona, Spain
| | - Sarah Béatrice Heili-Frades
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Hospital Universitario Fundación Jiménez Díaz Quirón Salud, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD, UAM), CIBERES, REVA Network, Madrid, Spain
| | | | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Pau, Barcelona, Spain
| | | | - Olga Mediano
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Sleep Unit, Pneumology Department. Hospital Universitario de Guadalajara, Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Universidad de Alcalá, Madrid, Spain
| | - Oriol Roca
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Parc Taulí-I3PT, Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Javier García Fernández
- Servicio de Anestesiología, UCI Quirúrgica y U. Dolor. H. U. Puerta de Hierro, Madrid, Spain
| | | | | | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain
| | - Teresa Millán
- Servicio de Medicina Intensiva Hospital Universitario Son Espases, Facultad de Medicina de las Islas Baleares, Spain
| | - Miquel Ferrer Monreal
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; UVIIR, Servei de Pneumologia, Institut de Respiratori, Clínic Barcelona, IDIBAPS. Universitat de Barcelona, Barcelona, Spain
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Lorente-González M, Terán-Tinedo JR, Zevallos-Villegas A, Laorden D, Mariscal-Aguilar P, Suárez-Ortiz M, Cano-Sanz E, Ortega-Fraile MÁ, Hernández-Núñez J, Falcone A, Saiz-Lou EM, Plaza-Moreno MC, García-Fadul C, Valle-Falcones M, Sánchez-Azofra A, Funes-Moreno C, De-La-Calle-Gil I, Navarro-Casado R, Carballo-López D, Gholamian-Ovejero S, Gallego-Rodríguez B, Villén-Villegas T, Landete P. Severe SARS-CoV-2 Pneumonia and Pneumomediastinum/Pneumothorax: A Prospective Observational Study in an Intermediate Respiratory Care Unit. J Intensive Care Med 2023; 38:1023-1041. [PMID: 37306158 PMCID: PMC10261956 DOI: 10.1177/08850666231180165] [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] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The occurrence of pneumomediastinum (PM) and/or pneumothorax (PTX) in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was evaluated. METHODS This was a prospective observational study conducted in patients admitted to the intermediate respiratory care unit (IRCU) of a COVID-19 monographic hospital in Madrid (Spain) between December 14, 2020 and September 28, 2021. All patients had a diagnosis of severe SARS-CoV-2 pneumonia and required noninvasive respiratory support (NIRS): high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The incidences of PM and/or PTX, overall and by NIRS, and their impact on the probabilities of invasive mechanical ventilation (IMV) and death were studied. RESULTS A total of 1306 patients were included. 4.3% (56/1306) developed PM/PTX, 3.8% (50/1306) PM, 1.6% (21/1306) PTX, and 1.1% (15/1306) PM + PTX. 16.1% (9/56) of patients with PM/PTX had HFNC alone, while 83.9% (47/56) had HFNC + CPAP/BiPAP. In comparison, 41.7% (521/1250) of patients without PM and PTX had HFNC alone (odds ratio [OR] 0.27; 95% confidence interval [95% CI] 0.13-0.55; p < .001), while 58.3% (729/1250) had HFNC + CPAP/BiPAP (OR 3.73; 95% CI 1.81-7.68; p < .001). The probability of needing IMV among patients with PM/PTX was 67.9% (36/53) (OR 7.46; 95% CI 4.12-13.50; p < .001), while it was 22.1% (262/1185) among patients without PM and PTX. Mortality among patients with PM/PTX was 33.9% (19/56) (OR 4.39; 95% CI 2.45-7.85; p < .001), while it was 10.5% (131/1250) among patients without PM and PTX. CONCLUSIONS In patients admitted to the IRCU for severe SARS-CoV-2 pneumonia requiring NIRS, incidences of PM/PTX, PM, PTX, and PM + PTX were observed to be 4.3%, 3.8%, 1.6%, and 1.1%, respectively. Most patients with PM/PTX had HFNC + CPAP/BiPAP as the NIRS device, much more frequently than patients without PM and PTX. The probabilities of IMV and death among patients with PM/PTX were 64.3% and 33.9%, respectively, higher than those observed in patients without PM and PTX, which were 21.0% and 10.5%, respectively.
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Affiliation(s)
- Miguel Lorente-González
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - José Rafael Terán-Tinedo
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Annette Zevallos-Villegas
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Daniel Laorden
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Pablo Mariscal-Aguilar
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Miguel Suárez-Ortiz
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Eduardo Cano-Sanz
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - María Ángeles Ortega-Fraile
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Joaquín Hernández-Núñez
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Adalgisa Falcone
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Elena María Saiz-Lou
- Department of Internal Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - María Cristina Plaza-Moreno
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Christian García-Fadul
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Manuel Valle-Falcones
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Ana Sánchez-Azofra
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Clotilde Funes-Moreno
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Isabel De-La-Calle-Gil
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Rosalía Navarro-Casado
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Daniel Carballo-López
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Soraya Gholamian-Ovejero
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Berta Gallego-Rodríguez
- Department of Anaesthesiology and Resuscitation, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Tomás Villén-Villegas
- Department of Emergency Medicine, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
| | - Pedro Landete
- Department of Pneumology, Intermediate Respiratory Care Unit, Hospital de Emergencias Enfermera Isabel Zendal [Nurse Isabel Zendal Emergency Hospital], Madrid, Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid [Autónoma University of Madrid], Madrid, Madrid, Spain
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García-Fernández JJ, Sánchez-Nicolás JA, Galicia-Puyol S, Gil-Rosa I, Guerras-Conesa JJ, Bernal-Morell E, Cinesi-Gómez C. Failure of Non-Invasive Respiratory Support in Patients with SARS-CoV-2. J Clin Med 2023; 12:6537. [PMID: 37892675 PMCID: PMC10607690 DOI: 10.3390/jcm12206537] [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: 09/20/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION The objective of this study is to assess the failure of therapies with HFNO (high-flow nasal oxygen), CPAP, Bilevel, or combined therapy in patients with hypoxemic acute respiratory failure due to SARS-CoV-2 during their hospitalization. METHODS This was a retrospective and observational study of SARS-CoV-2-positive patients who required non-invasive respiratory support (NIRS) at the Reina Sofía General University Hospital of Murcia between March 2020 and May 2021. RESULTS Of 7355 patients, 197 (11.8%) were included; 95 of them failed this therapy (48.3%). We found that during hospitalization in the ward, the combined therapy of HFNO and CPAP had an overall lower failure rate and the highest treatment with Bilevel (p = 0.005). In the comparison of failure in therapy without two levels of airway pressure, HFNO, CPAP, and combined therapy of HFNO with CPAP, (35.6% of patients) presented with 24.2% failure, compared to those who had two levels of pressure with Bilevel and combined therapy of HFNO with Bilevel (64.4% of patients), with 75.8% associated failure (OR: 0, 374; CI 95%: 0.203-0.688. p = 0.001). CONCLUSIONS The use of NIRS during conventional hospitalization is safe and effective in patients with respiratory failure secondary to SARS-CoV-2 infection. The therapeutic strategy of Bilevel increases the probability of failure, with the combined therapy strategy of CPAP and HFNO being the most promising option.
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Affiliation(s)
- Juan Javier García-Fernández
- Health Sciences PhD Program, Catholic University of Murcia UCAM, Campus de los Jerónimos nº135, Guadalupe, 30107 Murcia, Spain;
| | | | - Sonia Galicia-Puyol
- Emergency Department, Los Arcos del Mar Menor General University Hospital, 30739 Murcia, Spain
| | - Isabel Gil-Rosa
- Emergency Department, Reina Sofía General University Hospital, 30003 Murcia, Spain (C.C.-G.)
| | | | - Enrique Bernal-Morell
- Infectious Diseases Department, Reina Sofía General University Hospital, 30003 Murcia, Spain
| | - César Cinesi-Gómez
- Emergency Department, Reina Sofía General University Hospital, 30003 Murcia, Spain (C.C.-G.)
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Gutiérrez López R, Ares Castro-Conde B, López Reboiro ML, Sardiña González C, López Mouriño VM, Pereyra Barrionuevo M, Castro Pérez A, Martínez Pillado M, López Castro J. Effectiveness of the contingency plan for social and health care during the COVID-19 pandemic in a health district in northwestern Spain. Rev Esp Geriatr Gerontol 2023; 58:101393. [PMID: 37647836 DOI: 10.1016/j.regg.2023.101393] [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: 04/17/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic, healthcare facilities have implemented contingency plans to minimize the consequences of this pathology however, the deployment and results of these contingency plans are scarcely shared. OBJECTIVES To describe the implementation of the contingency plan in the social and health care in the COVID-19 pandemic in the Public Hospital of Monforte (Lugo, Spain) and to evaluate the effectiveness of the measures included in this plan. METHOD Phenomenological sampling conducted between March 10 and May 15, 2020. Evaluation qualitative assessment by an external quality improvement team of the Galician Health Service (SERGAS), based on the Practicum Direct rapid structured checklist in risk management, organizational management, and evaluation of decision making. As outcome indicators, we assessed the number of hospital admissions, number of PCRs performed, telephone attention to social and health social-healthcare patients, number of hospitalizations avoided and estimation of their direct cost. RESULTS After assessing and managing the risks, an information security plan was developed and solutions to minimize complications in our patients derived from this pandemic. An emergency decision making team was created, as well as an employee communication mechanism for employees through standardized documents and documentation channels. CONCLUSIONS The adaptation of the Practicum Direct rapid model to the healthcare setting is a useful and easy-to-apply tool that allows us to identify weak points and areas for improvement in our Service and thus to strengthen patient care in all clinical areas, improving the quality of care.
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Affiliation(s)
| | | | | | | | | | | | - Asel Castro Pérez
- Anesthesiology, Resuscitation and Pain Clinic Department, Hospital Público de Monforte de Lemos, Lugo, Spain
| | - Modesto Martínez Pillado
- Quality Department, Área Sanitaria de Pontevedra e O Salnés, Pontevedra, Spain; Galicia Sur Health Research Institute, SERGAS-UVIGO, Spain
| | - José López Castro
- Internal Medicine Department, Hospital Público de Monforte de Lemos, Lugo, Spain.
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López-Ramírez VY, Sanabria-Rodríguez OO, Bottia-Córdoba S, Muñoz-Velandia OM. Delayed mechanical ventilation with prolonged high-flow nasal cannula exposure time as a risk factor for mortality in acute respiratory distress syndrome due to SARS-CoV-2. Intern Emerg Med 2023; 18:429-437. [PMID: 36792855 PMCID: PMC9931170 DOI: 10.1007/s11739-022-03186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/19/2022] [Indexed: 02/17/2023]
Abstract
In a high proportion of patients, infection by COVID-19 progresses to acute respiratory distress syndrome (ARDS), requiring invasive mechanical ventilation (IMV) and admission to an intensive care unit (ICU). Other devices, such as a high-flow nasal cannula (HFNC), have been alternatives to IMV in settings with limited resources. This study evaluates whether HFNC exposure time prior to IMV is associated with mortality. This observational, analytical study was conducted on a historical cohort of adults with ARDS due to SARS-CoV-2 who were exposed to HFNC and subsequently underwent IMV. Univariate and multivariate logistic regression was used to analyze the impact of HFNC exposure time on mortality, controlling for multiple potential confounders. Of 325 patients with ARDS, 41 received treatment with HFNC for more than 48 h before IMV initiation. These patients had a higher mortality rate (43.9% vs. 27.1%, p: 0.027) than those using HFNC < 48 h. Univariate analysis evidenced an association between mortality and HFNC ≥ 48 h (OR 2.16. 95% CI 1.087-4.287. p: 0.028). Such an association persisted in the multivariable analysis (OR 2.21. 95% CI 1.013-4.808. p: 0.046) after controlling for age, sex, comorbidities, basal severity of infection, and complications. This study also identified a significant increase in mortality after 36 h in HFNC (46.3%, p: 0.003). In patients with ARDS due to COVID-19, HFNC exposure ≥ 48 h prior to IMV is a factor associated with mortality after controlling multiple confounders. Physiological mechanisms for such an association are need to be defined.
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MacLoughlin R, Martin-Loeches I. Not all nebulizers are created equal: Considerations in choosing a nebulizer for aerosol delivery during mechanical ventilation. Expert Rev Respir Med 2023; 17:131-142. [PMID: 36803134 DOI: 10.1080/17476348.2023.2183194] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
INTRODUCTION Aerosol therapy is commonly prescribed in the mechanically ventilated patient. Jet nebulizers (JN) and vibrating mesh nebulizers (VMN) are the most common nebulizer types, however, despite VMN's well established superior performance, JN use remains the most commonly used of the two. In this review, we describe the key differentiators between nebulizer types and how considered selection of nebulizer type may enable successful therapy and the optimization of drug/device combination products. AREAS COVERED Following a review of the published literature up to February 2023, the current state of the art in relation to JN and VMN is discussed under the headings of in vitro performance of nebulizers during mechanical ventilation, respective compatibility with formulations for inhalation, clinical trials making use of VMN during mechanical ventilation, distribution of nebulized aerosol throughout the lung, measuring the respective performance of nebulizers in the patient and non-drug delivery considerations in nebulizer choice. EXPERT OPINION Whether for standard care, or the development of drug/device combination products, the choice of nebulizer type should not be made without consideration of the unique needs of the combination of each of drug, disease and patient types, as well as target site for deposition, and healthcare professional and patient safety.
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Affiliation(s)
- Ronan MacLoughlin
- Research and Development, Science and Emerging Technologies, Aerogen Ltd, Dangan, Ireland.,School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
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Mediano O, Luján M, López-Monzoni S. An Intermediate Respiratory Care Unit in Every Hospital. Arch Bronconeumol 2023; 59:7-9. [PMID: 36336546 DOI: 10.1016/j.arbres.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain; Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain.
| | - Manel Luján
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Servicio de Neumología, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Sonia López-Monzoni
- Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Blanco MC, Vergara AM, Voth AH, Catalán JS. Mujer de 40 años ingresada por neumonía secundaria a una infección por SARS-CoV-2 que a los 10 días de su ingreso presenta un nuevo empeoramiento respiratorio. Medicine (Baltimore) 2022; 13:3922.e1-3922.e3. [PMID: 36277306 PMCID: PMC9579811 DOI: 10.1016/j.med.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Higher mortality and intubation rate in COVID-19 patients treated with noninvasive ventilation compared with high-flow oxygen or CPAP. Sci Rep 2022; 12:6527. [PMID: 35444251 PMCID: PMC9020755 DOI: 10.1038/s41598-022-10475-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
The effectiveness of noninvasive respiratory support in severe COVID-19 patients is still controversial. We aimed to compare the outcome of patients with COVID-19 pneumonia and hypoxemic respiratory failure treated with high-flow oxygen administered via nasal cannula (HFNC), continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV), initiated outside the intensive care unit (ICU) in 10 university hospitals in Catalonia, Spain. We recruited 367 consecutive patients aged ≥ 18 years who were treated with HFNC (155, 42.2%), CPAP (133, 36.2%) or NIV (79, 21.5%). The main outcome was intubation or death at 28 days after respiratory support initiation. After adjusting for relevant covariates and taking patients treated with HFNC as reference, treatment with NIV showed a higher risk of intubation or death (hazard ratio 2.01; 95% confidence interval 1.32–3.08), while treatment with CPAP did not show differences (0.97; 0.63–1.50). In the context of the pandemic and outside the intensive care unit setting, noninvasive ventilation for the treatment of moderate to severe hypoxemic acute respiratory failure secondary to COVID-19 resulted in higher mortality or intubation rate at 28 days than high-flow oxygen or CPAP. This finding may help physicians to choose the best noninvasive respiratory support treatment in these patients. Clinicaltrials.gov identifier: NCT04668196.
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11
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Assessment of respiratory support decision and the outcome of invasive mechanical ventilation in severe COVID-19 with ARDS. JOURNAL OF INTENSIVE MEDICINE 2022; 2:92-102. [PMID: 36785779 PMCID: PMC8810377 DOI: 10.1016/j.jointm.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/12/2021] [Accepted: 12/10/2021] [Indexed: 01/15/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) is an ongoing pandemic. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods In this retrospective, single-center, case series study, patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8th, 2020, to March 24th, 2020, with the final follow-up date of April 20th, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results The study included 46 COVID-19-associated ARDS patients who required IMV. The median age of the 46 patients was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR]: 6.0-27.3) days, and the median respiratory support decision score was 11.0 (IQR: 7.8-16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3-17.0] vs. 8.5 (6.0-10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657-0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P < 0.001). Conclusions For severe COVID-19-associated ARDS with IMV, following the respiratory support decision and assessing completion would improve the progress of ventilation. With a decision score of >11.5, the mortality at 28 days after ICU admission showed an obvious decrease.
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12
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Monroe I, Dale M, Schwabe M, Schenkel R, Schenarts PJ. The COVID-19 Patient in the Surgical Intensive Care Unit. Surg Clin North Am 2022; 102:1-21. [PMID: 34800379 PMCID: PMC8479422 DOI: 10.1016/j.suc.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
COVID-19 continues to rampage around the world. Noncritical care-trained physicians may be deployed into the intensive care unit to manage these complex patients. Although COVID-19 is primarily a respiratory disease, it is also associated with significant pathology in the brain, heart, vasculature, lungs, gastrointestinal tract, and kidneys. This article provides an overview of COVID-19 using an organ-based, systematic approach.
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13
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Amer YS, Titi MA, Godah MW, Wahabi HA, Hneiny L, Abouelkheir MM, Hamad MH, ElGohary GM, Hamouda MB, Ouertatani H, Velasquez-Salazar P, Acosta-Reyes J, Alhabib SM, Esmaeil SA, Fedorowicz Z, Zhang A, Chen Z, Liptrott SJ, Frungillo N, Jamal AA, Almustanyir SA, Dieyi NU, Powell J, Hon KJ, Alzeidan R, Azzo M, Zambrano-Rico S, Ramirez-Jaramillo P, Florez ID. International alliance and AGREE-ment of 71 clinical practice guidelines on the management of critical care patients with COVID-19: a living systematic review. J Clin Epidemiol 2022; 142:333-370. [PMID: 34785346 PMCID: PMC8590623 DOI: 10.1016/j.jclinepi.2021.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/10/2021] [Accepted: 11/06/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to systematically identify and critically assess the clinical practice guidelines (CPGs) for the management of critically ill patients with COVID-19 with the AGREE II instrument. STUDY DESIGN AND SETTING We searched Medline, CINAHL, EMBASE, CNKI, CBM, WanFang, and grey literature from November 2019 - November 2020. We did not apply language restrictions. One reviewer independently screened the retrieved titles and abstracts, and a second reviewer confirmed the decisions. Full texts were assessed independently and in duplicate. Disagreements were resolved by consensus. We included any guideline that provided recommendations on the management of critically ill patients with COVID-19. Data extraction was performed independently and in duplicate by two reviewers. We descriptively summarized CPGs characteristics. We assessed the quality with the AGREE II instrument and we summarized relevant therapeutic interventions. RESULTS We retrieved 3,907 records and 71 CPGs were included. Means (Standard Deviations) of the scores for the 6 domains of the AGREE II instrument were 65%(SD19.56%), 39%(SD19.64%), 27%(SD19.48%), 70%(SD15.74%), 26%(SD18.49%), 42%(SD34.91) for the scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, editorial independence domains, respectively. Most of the CPGs showed a low overall quality (less than 40%). CONCLUSION Future CPGs for COVID-19 need to rely, for their development, on standard evidence-based methods and tools.
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Affiliation(s)
- Yasser S. Amer
- Pediatrics Department and Clinical Practice Guidelines Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia,Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University Medical Council, Alexandria University, Alexandria, Egypt
| | - Maher A. Titi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Patient Safety Unit, Quality Management Department King Saud University Medical City, Riyadh, Saudi Arabia
| | - Mohammad W. Godah
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hayfaa A. Wahabi
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Layal Hneiny
- Saab Medical Library, University Libraries, American University of Beirut, Beirut, Lebanon
| | | | - Muddathir H. Hamad
- Division of Neurology, Pediatrics Department, King Khalid University Hospital, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ghada Metwally ElGohary
- Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Cairo, Egypt,University Oncology Center, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamed Ben Hamouda
- Clinical Practice Guidelines Unit, INEAS l instance Nationale de l'évaluation et de l'accréditation en santé 7 Rue Ahmed Rami le belvedere 1001 Tunis-TUNISIA
| | - Hella Ouertatani
- Clinical Pathways Unit, National Authority for Assessment and Accreditation in Healthcare (INEAS), Tunis, Tunisia
| | - Pamela Velasquez-Salazar
- Unidad de Evidencia y Deliberación para la toma de Decisiones (UNED), Faculty of Medicine, University of Antioquia, Medellín, Colombia
| | - Jorge Acosta-Reyes
- Department of Public Health, Universidad del Norte, Barranquilla, Colombia
| | - Samia M. Alhabib
- National Center for Evidence-Based Health Practice, Saudi Health Council, Riyadh, Saudi Arabia,King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Samia Ahmed Esmaeil
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia
| | - Zbys Fedorowicz
- Veritas Health Sciences Consultancy Ltd., Huntingdon, United Kingdom
| | - Ailing Zhang
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Chen
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Niccolò Frungillo
- Oncology Unit, ASST Fatebenefratelli-Sacco, PO Fateberefratelli, Piazza Principessa Clotilde 3, 20121, Milan, Italy
| | - Amr A. Jamal
- Research Chair for Evidence-Based Health Care and Knowledge Translation, Deanship of Scientific Research, King Saud University, Riyadh, Saudi Arabia,Family & Community Medicine Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Newman Ugochukwu Dieyi
- Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada
| | - John Powell
- National Institute for Health and Care Excellence, London, UK,Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Katrina J. Hon
- Division of Community Health and Humanities, Memorial University, St. John's Newfoundland and Labrador, Canada,Neuroscience, Mind, Brain, and Behavior, Harvard University, MA, USA
| | - Rasmieh Alzeidan
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Majduldeen Azzo
- Pediatrics Emergency Department, The International Medical Center, Hail Street, 21451, Jeddah, Saudi Arabia
| | | | | | - Ivan D. Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia,School of Rehabilitation Science, McMaster University, Hamilton, Canada,Corresponding author: Tel.: +57 4 219 2480
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14
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Luján M, Sayas J, Mediano O, Egea C. Non-invasive Respiratory Support in COVID-19: A Narrative Review. Front Med (Lausanne) 2022; 8:788190. [PMID: 35059415 PMCID: PMC8763700 DOI: 10.3389/fmed.2021.788190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/30/2021] [Indexed: 12/20/2022] Open
Abstract
Acute respiratory failure secondary to COVID-19 pneumonia may require a variety of non-pharmacological strategies in addition to oxygen therapy to avoid endotracheal intubation. The response to all these strategies, which include high nasal flow, continuous positive pressure, non-invasive ventilation, or even prone positioning in awake patients, can be highly variable depending on the predominant phenotypic involvement. Deciding when to replace conventional oxygen therapy with non-invasive respiratory support, which to choose, the role of combined methods, definitions, and attitudes toward treatment failure, and improved case improvement procedures are directly relevant clinical questions for the daily care of critically ill COVID-19 patients. The experience accumulated after more than a year of the pandemic should lead to developing recommendations that give answers to all these questions.
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Affiliation(s)
- Manel Luján
- Pneumology Service, Hospital Universitari Parc Taulí, Sabadell, Spain.,Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain
| | - Javier Sayas
- Pneumology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Olga Mediano
- Pneumology Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Carlos Egea
- Centro de Investigacion Biomédica en Red (CIBERES), Madrid, Spain.,Hospital Universitario de Araba, Universidad País Vasco, Vitoria Gasteiz, Spain
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Masa JF, Patout M, Scala R, Winck JC. Reorganizing the respiratory high dependency unit for pandemics. Expert Rev Respir Med 2021; 15:1505-1515. [PMID: 34720022 DOI: 10.1080/17476348.2021.1997596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Respiratory high dependency units (RHDUs) set up in European countries in the last decade are based on being a transitional step between the intensive care units (ICUs) and the conventional hospital ward in terms of staffing, level of monitoring, and patients' severity. In the pre-COVID-19 era, its main use has been the treatment of hypercapnic acute-on-chronic respiratory failure with noninvasive respiratory support, and more recently, for hypoxemic acute respiratory failure. AREAS COVERED We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, limited to the terms: COVID-19 and RHDU, Respiratory Intermediate care Unit, acute respiratory distress syndrome (ARDS), noninvasive ventilation (NIV), high flow nasal cannula (HFNC), prone position, and monitoring. In this review, we summarize RHDU´s dual purpose: on the one hand, to decrease the number of admissions into ICU, and on the other hand, early discharges of patients from ICU with prolonged admissions due to the need of care or laborious weaning from invasive mechanical ventilation. Although this dual purpose of RHDUs has contributed to decrease the overload of the ICUs during the pandemic, the hundreds of patients admitted in hospitals, with approximately 20%-30% needing critical care, has exceeded the forecasts of many hospitals. EXPERT OPINION It seems clear that a reorganization and optimization of the care of patients with severe COVID-19 is necessary, minimizing admissions to the ICU and facilitating an early discharge. During the pandemic, several hospitals have spontaneously created new RHDUs or extended preexisting RHDUs or up-graded respiratory wards in order to receive less sick patients requiring lower levels of monitoring and nurse-to-patient ratios. This article reviews under a European expert perspective this topic and proposes an adaptation and optimization of the RHDUs to meet the emergent needs caused by the pandemic emphasizing the role of the expert application of noninvasive respiratory therapies in preventing intubation and ICU access.
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Affiliation(s)
- Juan Fernando Masa
- San Pedro De Alcantara Hospital, Cáceres, Spain.,Ciber De Enfermedades Respiratorias (Ciberes), Madrid, Spain.,Instituto Universitario De Investigación Biosanitaria De Extremadura (Inube), Spain
| | - Maxime Patout
- 1. Ap-hp, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service Des Pathologies Du Sommeil (Département R3S), Paris, France.,Sorbonne Université, Inserm, UMRS1158 Neurophysiologie Respiratoire Expérimentale Et Clinique, Paris, France
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit. Cardiovascular-thoracic-metabolic Department. Usl Toscana Sudest. San Donato Hospital, Arezzo, Italy
| | - Joao Carlos Winck
- Faculdade De Medicina Da Universidade Do Porto, Centro De Reabilitação Do Norte (Chvng), Vila Nova De Gaia, Portugal
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16
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Ferrer S, Sancho J, Bocigas I, Bures E, Mora H, Monclou E, Mulet A, Quezada A, Royo P, Signes-Costa J. ROX index as predictor of high flow nasal cannula therapy success in acute respiratory failure due to SARS-CoV-2. Respir Med 2021; 189:106638. [PMID: 34634500 PMCID: PMC8492361 DOI: 10.1016/j.rmed.2021.106638] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023]
Abstract
Background High-Flow Nasal Cannula (HFNC) therapy is useful treatment in patients with acute respiratory failure (ARF). The ROX index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) has been evaluated to predict success of HFNC in patients with pneumonia. Objective The aim of this study was to determine whether the ROX Index could predict HFNC therapy success in patients with ARF due to SARS-CoV-2 pneumonia. Methods An observational, prospective study was performed including patients admitted with ARF secondary to SARS-CoV-2 pneumonia who met criteria for HFNC therapy initiation. Demographic, radiological, laboratory and clinical course data were collected. The ROX index was calculated at 1 h, 6 h, 12 h and 24 h after starting HFNC. Results In total 85 patients were included (age, 64.51 + 11.78 years; male, 69.4%). HFNC failed in 47 (55.3%) patients, of whom 45 (97.8%) were initially managed with noninvasive ventilation (NIV). ROX index at 24 h was the best predictor of HFNC success (AUC 0.826, 95%CI 0.593–1.00, p = 0.015) with a cut-off point of 5.35 (S 0.91, Sp 0.79, PPV 0.92, NPP 0.79). In multivariate logistic regression analysis ROX index at 24 h proved the best predictor of HFNC success. Conclusions ROX index at 24 h with a cut-off point of 5.35 predicts HFNC success in patients with SARS-Cov-2-induced ARF.
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Affiliation(s)
- Santos Ferrer
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Jesús Sancho
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain.
| | - Irene Bocigas
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Enric Bures
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Heidi Mora
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Erik Monclou
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Alba Mulet
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Antonio Quezada
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Pablo Royo
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
| | - Jaime Signes-Costa
- Respiratory Medicine Department, Hospital Clínico Universitario, Valencia, Spain; Institue of Health Research INCLIVA, Valencia, Spain
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17
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Jiménez-Ruiz CA, Valido Morales A, Perez Chica G, Urrutia Landa I, Rodriguez Portal JA, Arnedillo Muñoz A, Cózar Bernal F, Peces-Barba G, Diego Roza C, Solano Reina S, Rodriguez Suarez P, Garcia Rio F, Salas Llinas E, Garcia Clemente MM, Valencia Gallardo JM, Rodriguez Nieto MJ, Martin de Carpi T, Sánchez de Cos Escuin J, Estrada Trigueros G, Godoy Mayoral R, Barbeta Sánchez E, Fernández Villar A, Ros Lucas JA, Martinez Moragón E, Tomás López L. [Key Pulmonology and Thoracic Surgery Issues under Discussion in the COVID-19 Era]. OPEN RESPIRATORY ARCHIVES 2021; 3:100123. [PMID: 38620959 PMCID: PMC8372421 DOI: 10.1016/j.opresp.2021.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Agustin Valido Morales
- Director del Comité de Relaciones Institucionales de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Gerardo Perez Chica
- Secretario del Comité de Relaciones Institucionales de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Isabel Urrutia Landa
- Coordinadora del Año SEPAR por la Calidad del Aire. Cambio Climático y Salud, España
| | | | | | - Fernando Cózar Bernal
- Servicio de Cirugía Torácica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - Germán Peces-Barba
- Vicepresidente Neumólogo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Carmen Diego Roza
- Secretaria General de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | | | - Pedro Rodriguez Suarez
- Vice-Presidente Cirujano Torácico de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | - Francisco Garcia Rio
- Presidente Electo de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), España
| | | | | | | | | | | | | | | | - Raúl Godoy Mayoral
- Presidente de la Sociedad Castellano-Manchega de Patología Respiratoria (SOCAMPAR), España
| | | | | | - Jose Antonio Ros Lucas
- Presidente de la Sociedad Murciana de Patología del Aparato Respiratorio (SOMUPAR), España
| | | | - Laura Tomás López
- Presidenta de la Sociedad Vasco-Navarra de Patología Respiratoria (SVNPAR), España
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18
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Fuchs A, Lanzi D, Beilstein CM, Riva T, Urman RD, Luedi MM, Braun M. Clinical recommendations for in-hospital airway management during aerosol-transmitting procedures in the setting of a viral pandemic. Best Pract Res Clin Anaesthesiol 2021; 35:333-349. [PMID: 34511223 PMCID: PMC7723398 DOI: 10.1016/j.bpa.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.
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Affiliation(s)
- Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Daniele Lanzi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Matthias Braun
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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19
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Chavarria AP, Lezama ES, Navarro MG, Vazquez RRV, Bello HH, Gascon JL, Juárez LM, Avendaño MA, Gonzalez LER, Ville Benavides R, Wyssmann RVÁ, Ortiz BS, de la Cerda MLR, Castañeda LM, Martinez-Juarez LA, Gallardo-Rincón H, Tapia-Conyer R. High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19. Ther Adv Infect Dis 2021; 8:20499361211042959. [PMID: 34497714 PMCID: PMC8419547 DOI: 10.1177/20499361211042959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/09/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction: High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial. Methods: We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure. Results: HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6–75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09–1.47; p < 0.01), Rox index at 1 hour (0.82, 0.7–0.96; p = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19–0.62; p < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11–20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20–36) days, respectively]. Conclusion: Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.
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Affiliation(s)
| | - Erika Salinas Lezama
- Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico
| | | | | | - Héctor Herrera Bello
- Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico
| | - Julieta Lomelín Gascon
- Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico
- Fundación Carlos Slim, Miguel Hidalgo, Mexico City, Mexico
| | - Linda Morales Juárez
- Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico
| | | | | | | | | | - Brenda Sandoval Ortiz
- Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico
| | | | - Lidia Moreno Castañeda
- Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico
| | - Luis Alberto Martinez-Juarez
- Fundación Carlos Slim, Miguel Hidalgo, Mexico City, Mexico
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Roberto Tapia-Conyer
- Fundación Carlos Slim, Miguel Hidalgo, Mexico City, Mexico
- National Autonomous University of Mexico, Coyoacán, Mexico City, Mexico
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20
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Battaglini D, Robba C, Ball L, Silva PL, Cruz FF, Pelosi P, Rocco PRM. Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review. Br J Anaesth 2021; 127:353-364. [PMID: 34217468 PMCID: PMC8173496 DOI: 10.1016/j.bja.2021.05.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/17/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022] Open
Abstract
COVID-19 pneumonia is associated with hypoxaemic respiratory failure, ranging from mild to severe. Because of the worldwide shortage of ICU beds, a relatively high number of patients with respiratory failure are receiving prolonged noninvasive respiratory support, even when their clinical status would have required invasive mechanical ventilation. There are few experimental and clinical data reporting that vigorous breathing effort during spontaneous ventilation can worsen lung injury and cause a phenomenon that has been termed patient self-inflicted lung injury (P-SILI). The aim of this narrative review is to provide an overview of P-SILI pathophysiology and the role of noninvasive respiratory support in COVID-19 pneumonia. Respiratory mechanics, vascular compromise, viscoelastic properties, lung inhomogeneity, work of breathing, and oesophageal pressure swings are discussed. The concept of P-SILI has been widely investigated in recent years, but controversies persist regarding its mechanisms. To minimise the risk of P-SILI, intensivists should better understand its underlying pathophysiology to optimise the type of noninvasive respiratory support provided to patients with COVID-19 pneumonia, and decide on the optimal timing of intubation for these patients.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Pedro L Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; COVID-19 Virus Network, Ministry of Science, Technology, and Innovation, Brasilia, Brazil
| | - Fernanda F Cruz
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; COVID-19 Virus Network, Ministry of Science, Technology, and Innovation, Brasilia, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; COVID-19 Virus Network, Ministry of Science, Technology, and Innovation, Brasilia, Brazil.
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21
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Frat JP, Thille AW, Arrivé F, Lujan M, Rello J. What is the most adequate non-invasive oxygen support for acute hypoxaemic respiratory failure due to COVID-19? Anaesth Crit Care Pain Med 2021; 40:100909. [PMID: 34157444 PMCID: PMC8214315 DOI: 10.1016/j.accpm.2021.100909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Jean-Pierre Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France.
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France; INSERM, CIC-1402 ALIVE, University of Poitiers, Poitiers, France
| | - François Arrivé
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Manel Lujan
- Intermediate ICU at the Respiratory Department in Parc Tauli Hospital, Sabadell, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Jordi Rello
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid 28029, Spain; Vall d'Hebron Institute of Research, Barcelona 08017, Spain; Research in Critical Care, CHU Caremeau, Nîmes 30900, France
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22
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Suarez-Cuartin G, Gasa M, Bermudo G, Ruiz Y, Hernandez-Argudo M, Marin A, Trias-Sabria P, Cordoba A, Cuevas E, Sarasate M, Ariza A, Sabater J, Romero N, Subirana C, Molina-Molina M, Santos S. Clinical Outcomes of Severe COVID-19 Patients Admitted to an Intermediate Respiratory Care Unit. Front Med (Lausanne) 2021; 8:711027. [PMID: 34277674 PMCID: PMC8280318 DOI: 10.3389/fmed.2021.711027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/09/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU. Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality. Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; p < 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31-7.42; p < 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61-5.43; p < 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p < 0.001). Conclusions: IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.
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Affiliation(s)
- Guillermo Suarez-Cuartin
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Merce Gasa
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Guadalupe Bermudo
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Yolanda Ruiz
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Marta Hernandez-Argudo
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Alfredo Marin
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Pere Trias-Sabria
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ana Cordoba
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ester Cuevas
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Mikel Sarasate
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Albert Ariza
- Cardiology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Joan Sabater
- Critical Care Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Nuria Romero
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Cristina Subirana
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Maria Molina-Molina
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Salud Santos
- Respiratory Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
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23
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Winck JC, Scala R. Non-invasive respiratory support paths in hospitalized patients with COVID-19: proposal of an algorithm. Pulmonology 2021; 27:305-312. [PMID: 33516668 PMCID: PMC7816939 DOI: 10.1016/j.pulmoe.2020.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
COVID-19 related Acute Respiratory Failure, may be successfully treated with Conventional Oxygen therapy, High Flow Nasal Cannula, Continuous Positive Airway Pressure or Bi-level Positive-Pressure ventilation. Despite the accumulated data in favor of the use of different Non-invasive Respiratory therapies in COVID-19 related Acute Respiratory Failure, it is not fully understood when start, escalate and de-escalate the best respiratory supportive option for the different timing of the disease. Based on the current published experience with Non-invasive Respiratory therapies in COVID-19 related Acute Respiratory Failure, we propose an algorithm in deciding when to start, when to stop and when to wean different NIRT. This strategy may help clinicians in better choosing NIRT during this second COVID-19 wave and beyond.
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Affiliation(s)
- J C Winck
- Facultyof Medicine-Porto University, Portugal.
| | - R Scala
- Pulmonology and Respiratory Intensive Care Unit, S Donato Hospital, Arezzo, Italy
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24
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients With Severe Acute Respiratory Failure. Arch Bronconeumol 2021; 57:415-427. [PMID: 34088393 DOI: 10.1016/j.arbr.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analog classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, Spain
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid, Spain; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, Spain
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres, Spain; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid, Spain; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, Spain
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, Spain; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, Spain
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, Spain
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, Spain
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, Spain
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25
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Evaluation of Aerosol Therapy during the Escalation of Care in a Model of Adult Cystic Fibrosis. Antibiotics (Basel) 2021; 10:antibiotics10050472. [PMID: 33919035 PMCID: PMC8142975 DOI: 10.3390/antibiotics10050472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/18/2022] Open
Abstract
Lung disease is the main cause of morbidity and mortality in cystic fibrosis (CF). CF patients inhale antibiotics regularly as treatment against persistent bacterial infections. The goal of this study was to investigate the effect of clinical intervention on aerosol therapy during the escalation of care using a bench model of adult CF. Droplet size analysis of selected antibiotics was completed in tandem with the delivered aerosol dose (% of total dose) assessments in simulations of various interventions providing oxygen supplementation or ventilatory support. Results highlight the variability of aerosolised dose delivery. In the homecare setting, the vibrating mesh nebuliser (VMN) delivered significantly more than the jet nebuliser (JN) (16.15 ± 0.86% versus 6.51 ± 2.15%). In the hospital setting, using VMN only, significant variability was seen across clinical interventions. In the emergency department, VMN plus mouthpiece (no supplemental oxygen) was seen to deliver (29.02 ± 1.41%) versus low flow nasal therapy (10 L per minute (LPM) oxygen) (1.81 ± 0.47%) and high flow nasal therapy (50 LPM oxygen) (3.36 ± 0.34%). In the ward/intensive care unit, non-invasive ventilation recorded 19.02 ± 0.28%, versus 22.64 ± 1.88% of the dose delivered during invasive mechanical ventilation. These results will have application in the design of intervention-appropriate aerosol therapy strategies and will be of use to researchers developing new therapeutics for application in cystic fibrosis and beyond.
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26
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Chiner E, Boira I, Esteban V, Betlloch I. Pressure ulcers due to high-flow nasal cannula oxygen therapy in a patient with SARS-CoV-2 infection. Arch Bronconeumol 2021; 57:44. [PMID: 34629645 PMCID: PMC7938746 DOI: 10.1016/j.arbres.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Eusebi Chiner
- Servicio de Neumología,. Hospital Universitario San Juan de Alicante, Alicante, España.
| | - Ignacio Boira
- Servicio de Neumología,. Hospital Universitario San Juan de Alicante, Alicante, España
| | - Violeta Esteban
- Servicio de Neumología,. Hospital Universitario San Juan de Alicante, Alicante, España
| | - Isabel Betlloch
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
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27
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Singh A, Khanna P, Sarkar S. High-Flow Nasal Cannula, a Boon or a Bane for COVID-19 Patients? An Evidence-Based Review. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:101-106. [PMID: 33679254 PMCID: PMC7921283 DOI: 10.1007/s40140-021-00439-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This review instantiates the efficacy and safety of HFNC in the context of COVID-19 pandemic. RECENT FINDINGS Globally, the healthcare system is facing an unprecedented crisis of resources due to the 2019 novel coronavirus disease (COVID-19) pandemic. Fever, cough, dyspnea, myalgia, fatigue, and pneumonia are the most common symptoms associated with it. The incidence of invasive mechanical ventilation in ICU patients ranges from 29.1 to 89.9%. Supplemental oxygen therapy is the main stay treatment for managing hypoxemic respiratory failure. The high-flow nasal cannula (HFNC) is a novel non-invasive strategy for better oxygenation and ventilation in critically ill patients. In this grim scenario, a reduction in mechanical ventilation by means of HFNC is of prime interest. SUMMARY HFNC is considered an aerosol-generating intervention with the risk of viral aerosolization with a concern of potential nosocomial transmission of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, there is no consensus regarding the use of HFNC in novel coronavirus-infected pneumonia (NCIP). HFNC seems to be an effective and safe treatment modality in acute respiratory failure with optimal settings and selection of ideal patients.
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Affiliation(s)
- Abhishek Singh
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Puneet Khanna
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Soumya Sarkar
- Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
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28
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Delorme M, Leroux K, Boussaid G, Lebret M, Prigent H, Leotard A, Louis B, Lofaso F. Protective Recommendations for Non-invasive Ventilation During COVID-19 Pandemic: A Bench Evaluation of the Effects of Instrumental Dead Space on Alveolar Ventilation. Arch Bronconeumol 2021; 57:28-33. [PMID: 34629640 PMCID: PMC8046339 DOI: 10.1016/j.arbres.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/02/2021] [Indexed: 12/14/2022]
Abstract
Introduction With the current COVID-19 pandemic, concerns have raised regarding the risk for NIV to promote airborne transmission. In case of hospital admission, continuation of therapy in patients undergoing chronic NIV is necessary and several protective circuit configurations have been recommended to reduce the risk of aerosol dissemination. However, all these configurations increase instrumental dead space. We therefore designed this study to evaluate their effects on the tidal volume (VTE) required to preserve stable end-tidal CO2 partial pressure (PETCO2) with constant respiratory rate. Methods A bench consisting of a test lung connected to an adult-sized mannequin head was set up. The model was ventilated through usual domiciliary configuration (single limb circuit with facial vented mask) which was used as reference. Then, five different circuit configurations including non-vented facial mask with viral/bacterial filter, modification of leak position, and change from single to double-limb circuit were evaluated. For each configuration, pressure support (PS) was gradually increased to reach reference PETCO2. Resulting VTE was recorded as primary outcome. Results Reference PETCO2 was 38(0) mmHg, with a PS set at 10 cmH2O, resulting in a VTE of 432(2) mL. Compared to reference, all the configurations evaluated required substantial increase in VTE to preserve alveolar ventilation, ranging from +79(2) to +216(1) mL. Conclusions Modifications of NIV configurations in the context of COVID-19 pandemic result in substantial increase of instrumental dead space. Re-evaluation of treatment efficiency and settings is crucial whenever protective measures influencing NIV equipment are considered.
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Affiliation(s)
- Mathieu Delorme
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France.
| | | | - Ghilas Boussaid
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France
| | - Marius Lebret
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec, QC, Canada
| | - Helene Prigent
- Service de Physiologie - Explorations Fonctionnelles, Unité des Pathologies du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3, 78000 Versailles, France
| | - Antoine Leotard
- Service de Physiologie - Explorations Fonctionnelles, Unité des Pathologies du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380 Garches, France; Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3, 78000 Versailles, France
| | - Bruno Louis
- INSERM, U955, Université Paris Est Créteil, Faculté de Médecine, CNRS ERL 7000, 94010 Créteil, France
| | - Frédéric Lofaso
- Université Paris-Saclay, UVSQ, ERPHAN, 78000 Versailles, France; Service de Physiologie - Explorations Fonctionnelles, Unité des Pathologies du Sommeil, AP-HP, Hôpital Raymond Poincaré, 92380 Garches, France
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29
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Neves VC, Souza JDOD, Koliski A, Miranda BS, Silva DCCE. High flow nasal cannula in asthmatic children with suspected COVID-19. FISIOTERAPIA EM MOVIMENTO 2021. [DOI: 10.1590/fm.2021.34302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The use of a high-flow nasal cannula as an alternative treatment for acute respiratory failure can reduce the need for invasive mechanical ventilation and the duration of hospital stays. Objective: The present study aimed to describe the use of a high-flow nasal cannula in pediatric asthmatic patients with acute respiratory failure and suspected COVID-19. Methods: To carry out this research, data were collected from medical records, including three patients with asthma diagnoses. The variables studied were: personal data (name, age in months, sex, weight, and color), clinical data (physical examination, PRAM score, respiratory rate, heart rate, and peripheral oxygen saturation), diagnosis, history of the current disease, chest, and laboratory radiography (arterial blood gases and reverse-transcriptase polymerase chain reaction). Clinical data were compared before and after using a high-flow nasal cannula. Results: After the application of the therapy, a gradual improvement in heart, respiratory rate, PaO2/FiO2 ratio, and the Pediatric Respiratory Assessment Measure score was observed. Conclusion: The simple and quick use of a high-flow nasal cannula in pediatric patients with asthma can be safe and efficient in improving their respiratory condition and reducing the need for intubation.
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Ramos Hernández C, Botana Rial M, Pazos Area LA, Núñez Fernández M, Pérez Fernández S, Rubianes González M, Crespo Casal M, Fernández Villar A. [Lung Ultrasound to Predict Unfavorable Progress in Patients Hospitalized for COVID-19]. Arch Bronconeumol 2021; 57:47-54. [PMID: 34629648 PMCID: PMC7505546 DOI: 10.1016/j.arbres.2020.07.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/28/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Thoracic ultrasound has been shown to be useful in the diagnosis of COVID-19 pulmonary involvement. Several scores for quantifying the degree of involvement have been described, although there is no evidence to show that they have any capacity for predicting unfavorable progress. METHODOLOGY Prospective cohort study of patients hospitalized for COVID-19. The sample was stratified according to clinical course, and patients requiring invasive or non-invasive respiratory support were classified as having unfavorable progress. Biomarkers were analyzed at admission and on the same day that thoracic ultrasound was performed. Prognostic scales were also determined at admission. The ultrasound score was obtained in 8 or 14 areas, depending on the patient's ability to sit. RESULTS We included 44 patients, 13 (29,5%) of whom subsequently needed ventilatory support. Eight areas were explored in all patients and 14 areas in 35 (79.5%). The most affected areas were the posterior lower lobes. Significant differences were found between the 2 groups on the SOFA and quick SOFA multidimensional scales, and PCR and LDH on the same day as thoracic ultrasound, and the ultrasound scores. The best area under the ROC curve (AUC) was obtained with the 14-area score, with a result of 0.88 (95% CI: 0.75-0.99). Its sensitivity and specificity for a cut-off score of 13.5 were 100% and 61.5%, respectively. CONCLUSIONS The use of scores to quantify lung involvement measured by thoracic ultrasound provides useful information, facilitating risk stratification in patients hospitalized with COVID-19.
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Affiliation(s)
- Cristina Ramos Hernández
- Departamento de Neumología, Hospital Álvaro Cunqueiro; Neumo Vigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
| | - Maribel Botana Rial
- Departamento de Neumología, Hospital Álvaro Cunqueiro; Neumo Vigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
| | - Luis Alberto Pazos Area
- Departamento de Neumología, Hospital Álvaro Cunqueiro; Neumo Vigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
| | - Marta Núñez Fernández
- Departamento de Neumología, Hospital Álvaro Cunqueiro; Neumo Vigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
| | | | | | | | - Alberto Fernández Villar
- Departamento de Neumología, Hospital Álvaro Cunqueiro; Neumo Vigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, España
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Luján M, Peñuelas Ó, Cinesi Gómez C, García-Salido A, Moreno Hernando J, Romero Berrocal A, Gutiérrez Ibarluzea I, Masa Jiménez JF, Mas A, Carratalá Perales JM, Gaboli M, Concheiro Guisán A, García Fernández J, Escámez J, Parrilla Parrilla J, Farrero Muñoz E, González M, Heili-Frades SB, Sánchez Quiroga MÁ, Rialp Cervera G, Hernández G, Sánchez Torres A, Uña R, Ferrando Ortolà C, Ferrer Monreal M, Egea Santaolalla C. Summary of Recommendations and Key Points of the Consensus of Spanish Scientific Societies (SEPAR, SEMICYUC, SEMES; SECIP, SENEO, SEDAR, SENP) on the Use of Non-Invasive Ventilation and High-Flow Oxygen Therapy with Nasal Cannulas in Adult, Pediatric, and Neonatal Patients with Severe Acute Respiratory Failure. Arch Bronconeumol 2020. [PMID: 33309418 DOI: 10.1016/j.arbres.2020.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-invasive respiratory support (NIRS) in adult, pediatric, and neonatal patients with acute respiratory failure (ARF) comprises two treatment modalities, non-invasive mechanical ventilation (NIMV) and high-flow nasal cannula (HFNC) therapy. However, experts from different specialties disagree on the benefit of these techniques in different clinical settings. The objective of this consensus was to develop a series of good clinical practice recommendations for the application of non-invasive support in patients with ARF, endorsed by all scientific societies involved in the management of adult and pediatric/neonatal patients with ARF. To this end, the different societies involved were contacted, and they in turn appointed a group of 26 professionals with sufficient experience in the use of these techniques. Three face-to-face meetings were held to agree on recommendations (up to a total of 71) based on a literature review and the latest evidence associated with 3 categories: indications, monitoring and follow-up of NIRS. Finally, the experts from each scientific society involved voted telematically on each of the recommendations. To classify the degree of agreement, an analogue classification system was chosen that was easy and intuitive to use and that clearly stated whether the each NIRS intervention should be applied, could be applied, or should not be applied.
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Affiliation(s)
- Manel Luján
- Servicio de Neumología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona; Universitat Autònoma de Barcelona, Barcelona; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Óscar Peñuelas
- Servicio de Medicina Intensiva y Grandes Quemados, Hospital Universitario de Getafe, Getafe, Madrid; CIBER de Enfermedades Respiratorias (CIBERES), Madrid; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - César Cinesi Gómez
- Servicio de Urgencias, Hospital General Universitario Reina Sofía. Director del Máster en Medicina de Urgencias y Emergencias de la Universidad Católica de Murcia (UCAM), Murcia, España
| | - Alberto García-Salido
- Servicio de Cuidados Intensivos Pediátricos e Investigador Posdoctoral en el Laboratorio de Investigación Biomédica, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Antonio Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | | | - Juan Fernando Masa Jiménez
- Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Instituto Universitario de Investigación Biosanitaria de Extremadura (INUBE), Cáceres, España
| | - Arantxa Mas
- Servei de Medicina Intensiva, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona; Hospital General d'Hospitalet, L'Hospitalet de Llobregat, Barcelona; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Mirella Gaboli
- Neumología Pediátrica y Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Javier García Fernández
- Servicio de Anestesia, Cuidados Críticos Quirúrgicos y Dolor, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, España
| | - Joaquín Escámez
- Servicio de Urgencias, Hospital Virgen de los Lirios, Alcoy, Alicante, España
| | - Julio Parrilla Parrilla
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Eva Farrero Muñoz
- Servei de Pneumologia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Mónica González
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Instituto de investigación Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - Sarah Béatrice Heili-Frades
- Neumología, Unidad de Cuidados Respiratorios Intermedios, Hospital Universitario Fundación Jiménez, Madrid; Díaz Quirón Salud. IIS. CIBERES, REVA Network, EMDOS, España
| | - María Ángeles Sánchez Quiroga
- Servicio de Neumología, Hospital Virgen del Puerto de Plasencia, Plasencia, Cáceres; CIBER de Enfermedades Respiratorias (CIBERES), ISCIII, Madrid; Instituto Universitario de Investigación Biosanitaria en Extremadura (INUBE), Cáceres, España
| | - Gemma Rialp Cervera
- Servicio de Medicina Intensiva, Hospital Universitari Son Llàtzer, Palma de Mallorca; Grupo de Trabajo de SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | - Gonzalo Hernández
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo; Grupo de Trabajo de la SEMICUYC de Insuficiencia Respiratoria Aguda, España
| | | | - Rafael Uña
- Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - Carlos Ferrando Ortolà
- Sección Área de Cuidados Intensivos Quirúrgicos, Servicio de Anestesia y Cuidados Intensivos, Hospital Clínic, Barcelona, España
| | - Miquel Ferrer Monreal
- Servei de Pneumologia, Institut del Tòrax, Hospital Clínic de Barcelona, IDIBAPS, CibeRes (CB06/06/0028), Universitat de Barcelona, Barcelona, España
| | - Carlos Egea Santaolalla
- Unidad Funcional de Sueño, Hospital Universitario Araba, OSI Araba, Vitoria-Gasteiz, Araba, España
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Caballero-Eraso C, Heili S, Mediano O. [Changes in Respiratory Units During COVID-19 Pandemic: The Role of Intermediate Respiratory Care Units in Spain]. OPEN RESPIRATORY ARCHIVES 2020; 2:303-304. [PMID: 38620753 PMCID: PMC7574861 DOI: 10.1016/j.opresp.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Candela Caballero-Eraso
- Unidad de Gestión Clínica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Sarah Heili
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
- Unidad de Cuidados Intermedios Respiratorios, Servicio de Neumología, IIS-Fundación Jiménez Díaz Quirón Salud, UAM, Madrid, España
- Réseau Européen de Ventilation Artificielle (REVA)
| | - Olga Mediano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
- Unidad de Sueño y Ventilación, Servicio de Neumología, Hospital Universitario de Guadalajara, Guadalajara, España
- Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España
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Ballesteros Sanz MÁ, Hernández-Tejedor A, Estella Á, Jiménez Rivera JJ, González de Molina Ortiz FJ, Sandiumenge Camps A, Vidal Cortés P, de Haro C, Aguilar Alonso E, Bordejé Laguna L, García Sáez I, Bodí M, García Sánchez M, Párraga Ramírez MJ, Alcaraz Peñarrocha RM, Amézaga Menéndez R, Burgueño Laguía P. [Recommendations of the Working Groups from the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of adult critically ill patients in the coronavirus disease (COVID-19)]. Med Intensiva 2020; 44:371-388. [PMID: 32360034 PMCID: PMC7142677 DOI: 10.1016/j.medin.2020.04.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 01/08/2023]
Abstract
On March 11, 2020, the Director-General of the World Health Organization (WHO) declared the disease caused by SARS-CoV-2 (COVID-19) as a pandemic. The spread and evolution of the pandemic is overwhelming the healthcare systems of dozens of countries and has led to a myriad of opinion papers, contingency plans, case series and emerging trials. Covering all this literature is complex. Briefly and synthetically, in line with the previous recommendations of the Working Groups, the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC) has prepared this series of basic recommendations for patient care in the context of the pandemic.
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Affiliation(s)
- M Á Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España.
| | | | - Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España
| | - J J Jiménez Rivera
- Servicio de Medicina Intensiva, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
| | | | - A Sandiumenge Camps
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - P Vidal Cortés
- Servicio de Medicina Intensiva, Complexo Hospitalario Universitario de Ourense, Ourense, España
| | - C de Haro
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Medicina Intensiva, CIBERES Enfermedades Respiratorias, Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - E Aguilar Alonso
- Servicio de Medicina Intensiva, Hospital Infanta Margarita, Cabra, Córdoba, España
| | - L Bordejé Laguna
- Servicio de Medicina Intensiva, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - I García Sáez
- Servicio de Medicina Intensiva, Hospital Universitario Donostia, San Sebastián, España
| | - M Bodí
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M García Sánchez
- Servicio de Medicina Intensiva, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M J Párraga Ramírez
- Servicio de Medicina Intensiva, Hospital General Universitario Morales Meseguer, Murcia, España
| | | | - R Amézaga Menéndez
- Servicio de Medicina Intensiva, Hospital Universitari Son Espases, Palma, Islas Baleares, España
| | - P Burgueño Laguía
- Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España
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Barreiro E, Jiménez C, García de Pedro J, Ramírez Prieto MT. COVID-19 and Pulmonology in the XXI century: Challenge or Opportunity? Arch Bronconeumol 2020. [PMID: 34025000 PMCID: PMC7253993 DOI: 10.1016/j.arbr.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Esther Barreiro
- Pulmonology Department, Muscle Wasting & Cachexia in Chronic Respiratory Diseases & Lung Cancer Research Group, Hospital Del Mar-IMIM, Parc De Salut Mar, Health and Experimental Sciences Department (CEXS), Universitat Pompeu Fabra (UPF), Parc De Recerca Biomèdica De Barcelona (PRBB), Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Barcelona
- Corresponding author.
| | - Carlos Jiménez
- Unidad Especializada En Tabaquismo, Hospital Clínico San Carlos, Madrid, Spain
| | - Julia García de Pedro
- Servicio De Neumología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense De Madrid, Madrid, Spain
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Winck JC, Ambrosino N. COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems. Pulmonology 2020; 26:213-220. [PMID: 32362507 PMCID: PMC7183996 DOI: 10.1016/j.pulmoe.2020.04.013] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023] Open
Abstract
Background and aim The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. Methods We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND: acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). Results Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200–300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100–200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1–2 h is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. Conclusion Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.
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Affiliation(s)
- J C Winck
- Faculdade de Medicina da Universidade do Porto, Portugal.
| | - N Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Istituto di Montescano, Italy
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Martinez-García MA, Villa C, Dobarganes Y, Girón R, Maíz L, García-Clemente M, Sibila O, Golpe R, Rodríguez J, Barreiro E, Rodriguez JL, Menéndez R, Prados C, de la Rosa D, Olveira C. RIBRON: The spanish Online Bronchiectasis Registry. Characterization of the First 1912 Patients. Arch Bronconeumol 2020; 57:28-35. [PMID: 32081438 DOI: 10.1016/j.arbres.2019.12.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/15/2019] [Accepted: 12/15/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The SEPAR Spanish Bronchiectasis Registry (RIBRON) began as a platform for the collection of longitudinal data on patients with this disease. The objective of this study is to describe its operation and to analyze the characteristics of bronchiectasis patients according to sex. METHODS A total of 1912 adult patients diagnosed with bronchiectasis in 43 centers were included between February 2015 and 2019. All patients had complete data consisting of at least 79 basic required variables, controlled by an external audit. RESULTS Mean age was 67.6 (15.2) years; 63.9% were women. The most common symptom was productive cough (78.3%) which was mucopurulent-purulent in 45.9% of cases. The most common etiology was post-infectious (40.4%), while 18.5% were idiopathic. Pseudomonas aeruginosa was the most frequently isolated microorganism (40.4%), of which 25.6% were associated with chronic infection. The annual number of mild-to-moderate/severe exacerbations was 1.62 (1.9)/0.59 (1.3). Half of the patients (50%) presented with airflow obstruction (17% severe). The most frequent radiological localization was lower lobes. The average FACED/E-FACED/BSI values were 2.06 (1.7)/2.67 (2.2)/7.8 (4.5), respectively. Overall, 66.7% of patients were taking inhaled corticosteroids, 19.2% macrolides, and 19.5% inhaled antibiotics. Women presented a less severe profile than men in clinical and functional terms, and a similar infectious, radiological and therapeutic profile. CONCLUSIONS RIBRON represents an excellent map of the characteristics of bronchiectasis in our country. Two thirds of patients are women who presented lower disease severity as a specific characteristic.
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Affiliation(s)
| | - Carmen Villa
- Servicio de Neumología, Clínica Fuensanta, Madrid, España
| | | | - Rosa Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, España
| | - Luis Maíz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España
| | - Marta García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Oriol Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, España
| | - Rafael Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, España
| | - Juan Rodríguez
- Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, España
| | - Esther Barreiro
- Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, España
| | | | - Rosario Menéndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - David de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, España
| | - Casilda Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, España
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Kumar P, Chaudhry D, Lalwani LK, Singh PK. Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak. Indian J Crit Care Med 2020; 24:835-837. [PMID: 33132569 PMCID: PMC7584838 DOI: 10.5005/jp-journals-10071-23591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aim To develop a device that can reduce the exposure of aerosols to healthcare workers (HCWs) who are working in coronavirus disease-2019 (COVID-19) critical units. Background Barrier enclosure has recently been proposed for use during intubations where the risk of aerosolization is high. In COVID-19 outbreak, use of noninvasive respiratory support is increasing. But at the same time, it is associated with high risk of aerosol generation, leading to infections among HCWs. We have made a modification in the intubation box and hence expanded its use with an aim to reduce COVID-19 exposure. Technique Vacuum suction tubing was attached to wall mount, and the other end of tubing was fixed, using adhesive surgical tapes, to the inside of the roof of barrier enclosure. Keeping the vacuum suction switched-on inside the box created a negative pressure while overall air flow is into the box from outside. This led us to believe that aerosols if generated are not contaminating patient's vicinity. Currently, we are using barrier enclosure boxes on all patients who are on noninvasive support (noninvasive ventilation or high-flow oxygen therapy). Conclusion and clinical significance We believe that adding barrier enclosure with the above-mentioned negative-pressure modification will provide an opportunity to use noninvasive support widely, while at the same time, HCW's exposure to aerosols will be reduced. How to cite this article Kumar P, Chaudhry D, Lalwani LK, Singh PK. Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak. Indian J Crit Care Med 2020;24(9):835-837.
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Affiliation(s)
- Prashant Kumar
- Department of Anaesthesiology and Critical Care, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Lokesh K Lalwani
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pawan K Singh
- Department of Pulmonary and Critical Care Medicine, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Seijo LM, Trujillo JC, Zulueta JJ. Screening in Lung Cancer: The Latest Evidence. Arch Bronconeumol 2019; 56:7-8. [PMID: 31204006 DOI: 10.1016/j.arbres.2019.04.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/17/2019] [Accepted: 04/25/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Luis M Seijo
- Clínica Universidad de Navarra, Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, España.
| | - Juan Carlos Trujillo
- Hospital de la Santa Creu i Sant Pau, Barcelona, España; Coordinador Área de Oncología Torácica, SEPAR, España
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