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Matthes S, Holl J, Randerath J, Treml M, Bockover M, Herkenrath S, Hagmeyer L, Knoch J, Oesterlee U, Sofianos G, Randerath W. Analysis of an Individualised Stepwise Approach to Non-Pharmacological Therapy in COVID-19. Respiration 2023; 102:833-842. [PMID: 37669641 PMCID: PMC10614468 DOI: 10.1159/000533522] [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: 06/15/2023] [Accepted: 07/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Early intubation versus use of conventional or high-flow nasal cannula oxygen therapy (COT/HFNC), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV) has been debated throughout the COVID-19 pandemic. Our centre followed a stepwise approach, in concordance with German national guidelines, escalating non-invasive modalities prior to invasive mechanical ventilation (IMV) or extracorporeal membrane oxygenation (ECMO), rather than early or late intubation. OBJECTIVES The aims of the study were to investigate the real-life usage of these modalities and analyse patient characteristics and survival. METHOD A retrospective monocentric observation was conducted of all consecutive COVID-19 hospital admissions between March 2020 and December 2021 at a university-affiliated pulmonary centre in Germany. Anthropometric data, therapy, and survival status were descriptively analysed. RESULTS From 1,052 COVID-19-related admissions, 835 patients were included (54% male, median 58 years). Maximum therapy was as follows: 34% (n = 284) no therapy, 40% (n = 337) COT, 3% (n = 22) HFNC, 9% (n = 73) CPAP, 7% (n = 56) NIV, 4% (n = 34) IMV, and 3% (n = 29) ECMO. Of 551 patients treated with at least COT, 12.3% required intubation. Overall, 183 patients required intensive unit care, and 106 (13%) died. Of the 68 patients who received IMV/ECMO, 48 died (74%). The strategy for non-pharmacological therapy was individual but remained consistent throughout the studied period. CONCLUSIONS This study provides valuable insight into COVID-19 care in Germany and shows how the majority of patients could be treated with the maximum treatment required according to disease severity following the national algorithm. Escalation of therapy modality is interlinked with disease severity and thus associated with mortality.
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Affiliation(s)
- Sandhya Matthes
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany,
| | - Johannes Holl
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Johannes Randerath
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Marcel Treml
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Michael Bockover
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Simon Herkenrath
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Lars Hagmeyer
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Johannes Knoch
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Ulrike Oesterlee
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Georgios Sofianos
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | - Winfried Randerath
- Bethanien Hospital, Clinic for Pneumology and Allergology, Centre of Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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Farhadi N, Varpaei HA, Fattah Ghazi S, Amoozadeh L, Mohammadi M. Deciding When to Intubate a COVID-19 Patient. Anesth Pain Med 2022; 12:e123350. [PMID: 36818481 PMCID: PMC9923339 DOI: 10.5812/aapm-123350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/29/2022] [Accepted: 04/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background The SARS-CoV-2 pandemic is one of the most significant challenges for healthcare providers, particularly in the critical care setting. The timing of intubation in COVID-19 patients seems to be challenging. Therefore, we aimed to investigate how it may have a survival benefit, and we determined which clinical characteristics were associated with outcomes. Methods This cross-sectional study was conducted in the Imam Khomeini Hospital Complex. We randomly selected patients admitted to intensive care units and, based on intubation status, categorized them into three subgroups (early, late, and not intubated). Early intubation is defined as intubation within 48 hours of ICU admission, and late intubation is defined as intubation after 48 hours of ICU admission. Results Early-intubated patients were more likely to have dyspnea than late-intubated patients, and late-intubated patients had a higher mean heart rate than early-intubated patients. The neutrophil/lymphocyte ratio was significantly (P < 0.05) lower in not-intubated patients than in other patients. There was no difference in NLR between early- and late-intubated patients. Mean serum creatine phosphokinase and troponin I levels were higher in late-intubated patients than in early- and not-intubated patients. Early-intubated patients had a lower ROX index than late-intubated patients. Patients with higher scores of APACHE 2, respiratory rates, and neutrophil to lymphocyte ratio were more likely to be intubated. Increasing APACHE and SOFA scores were associated with decreased odds of survival. Conclusions There were no statistically significant differences in total mortality between early- and late-intubated patients. APACHE 2 scores, NLR, RR, and history of ischemic heart disease are some of the appropriate predictors of intubation. Higher respiratory rates (tachypnea) can be an indicator of early intubation. The ROX index is one of the most sensitive and capable tools for predicting intubation. Intubation status is a potent predictor of in-hospital mortality.
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Affiliation(s)
| | - Hesam Aldin Varpaei
- Department of Nursing and Midwifery, Islamic Azad University Tehran Medical Sciences, Tehran, Iran
- Department of Surgical Nursing, Faculty of Nursing, Near East University, Nicosia, Cyprus
| | - Samrand Fattah Ghazi
- Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Laya Amoozadeh
- Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Mohammadi
- Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding Author: General ICU, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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