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Manole C, Dediu-Anghel M, Baroiu L, Ștefanopol IA, Nechifor A, Niculet E, Mihailov R, Moroianu LA, Voinescu DC, Firescu D. Efficiency of continuous positive airway pressure and high-flow nasal oxygen therapy in critically ill patients with COVID-19. J Int Med Res 2024; 52:3000605231222151. [PMID: 38194495 PMCID: PMC10777799 DOI: 10.1177/03000605231222151] [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: 07/25/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVE Critically ill patients with COVID-19 develop acute respiratory distress syndrome characterized by relatively well-preserved pulmonary compliance but severe hypoxemia. The challenge in managing such patients lies in optimizing oxygenation, which can be achieved through either high oxygen flow or noninvasive mechanical ventilation. This study was performed to compare the efficiency of two methods of noninvasive oxygen therapy: continuous positive airway pressure (CPAP) and high-flow nasal oxygen therapy (HFNO). METHODS This retrospective cohort study involved 668 patients hospitalized in the intensive care unit (ICU) of the "Sf. Apostol Andrei" Emergency Clinical Hospital, Galati, Romania from 1 April 2020 to 31 March 2021 (CPAP, n = 108; HFNO, n = 108). RESULTS Mortality was significantly lower in the CPAP and HFNO groups than in the group of patients who underwent intubation and mechanical ventilation after ICU admission. Mortality in the ICU was not significantly different between the CPAP and HFNO groups. CONCLUSIONS HFNO and CPAP represent efficient alternative therapies for patients with severe COVID-19 whose respiratory treatment has failed. Studies involving larger groups of patients are necessary to establish a personalized, more complex management modality for critically ill patients with COVID-19.
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Affiliation(s)
- Corina Manole
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Intensive Care Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Mihaela Dediu-Anghel
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Intensive Care Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Liliana Baroiu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Infectious Diseases Department, “Sf. Cuv. Parascheva” Infectious Diseases Clinical Hospital, Galati, Romania
| | - Ioana Anca Ștefanopol
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Ioan” Emergency Clinical Hospital for Children, Galati, Romania
| | - Alexandru Nechifor
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Multidisciplinary Integrated Center of Dermatological Interface Research Center (MIC-DIR), “Dunărea de Jos” University of Galat,i, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Pathology Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Raul Mihailov
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
| | - Lavinia Alexandra Moroianu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Psychiatry Department, “Elisabeta Doamna” Psychiatric Clinical Hospital, Galati, Romania
| | - Doina Carina Voinescu
- Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Medical Department, “Sfantul Apostol Andrei” Emergency County Clinical Hospital, Galati, Romania
| | - Dorel Firescu
- Clinical Surgical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galat,i, Romania
- Surgical Department, “Sfantul Apostol Andrei” Emergency Clinical Hospital, Galati, Romania
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Littlejohns A, Please H, Musasizi R, Murdoch S, Nampiina G, Waters I, Birch WD, de Boer G, Kapur N, Ambrozi T, Carol N, Noel N, Parmar J, Culmer P, Lawton T, Namulema E. Descriptive account of the first use of the LeVe CPAP System, a new frugal CPAP System, in adult patients with COVID-19 Pneumonitis in Uganda. Trop Med Health 2023; 51:42. [PMID: 37545001 PMCID: PMC10405477 DOI: 10.1186/s41182-023-00533-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) has been a key treatment modality for Coronavirus Disease 2019 (COVID-19) worldwide. Globally, the demand for CPAP outstripped the supply during the pandemic. The LeVe CPAP System was developed to provide respiratory support for treatment of COVID-19 and tailored for use in low- and middle-income country (LMIC) settings. Prior to formal trial approval, received in November 2021, these devices were used in extremis to support critically unwell adult patients requiring non-invasive ventilatory support. METHODS This is a retrospective descriptive review of adult patients with COVID-19 pneumonitis, who were treated with advanced respiratory support (CPAP and/or high-flow nasal oxygen, HFNO) at Mengo Hospital, Uganda. Patients were treated with the LeVe CPAP System, Elisa CPAP and/or AIRVO™ HFNO. Treatment was escalated per standard local protocols for respiratory failure, and CPAP was the maximum respiratory support available. Data were collected on patient characteristics, length of time of treatment, clinical outcome, and any adverse events. RESULTS Overall 333 patients were identified as COVID-19 positive, 44 received CPAP ± HFNO of which 43 were included in the study. The median age was 58 years (range 28-91 years) and 58% were female. The median duration of advanced respiratory support was 7 days (range 1-18 days). Overall (all device) mortality was 49% and this was similar between those started on the LeVe CPAP System and those started non-LeVe CPAP System devices (50% vs 47%). CONCLUSIONS The LeVe CPAP system was the most used CPAP device during the pandemic, bringing the hospital's number of available HFNO/CPAP devices from two to 14. They were a critical resource for providing respiratory support to the sickest group of patients when no alternative devices were available. The devices appear to be safe and well-tolerated with no serious adverse events recorded. This study is unable to assess the efficacy of the LeVe CPAP System; therefore, formal comparative studies are required to inform further use.
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Affiliation(s)
- Anna Littlejohns
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Helen Please
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Racheal Musasizi
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Stuart Murdoch
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Gorret Nampiina
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Ian Waters
- University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | | | | | - Nikil Kapur
- University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Tumwesigye Ambrozi
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Ninsiima Carol
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Nakigudde Noel
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda
| | - Jiten Parmar
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, West Yorkshire, UK
| | - Peter Culmer
- University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Tom Lawton
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Ln, Bradford, BD9 6RJ, UK
| | - Edith Namulema
- Mengo Hospital, Sir Albert Cook Road, Mengo, P. O. Box 7161, Kampala, Uganda.
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3
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Ward-Ambler E, Wallbridge P, Singh K, Miller A, Irving LB, Manser R, Goldin J, Hii S, Hammerschlag G, Rees M. An Australian COVID-19 respiratory care unit experience. Intern Med J 2023; 53:1115-1120. [PMID: 37183656 DOI: 10.1111/imj.16125] [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: 11/16/2022] [Accepted: 05/10/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a heterogeneous presentation ranging from severe pneumonitis to asymptomatic infection. International studies have demonstrated the utility of respiratory care units (RCUs) to facilitate the delivery of non-invasive ventilation techniques to patients with COVID-19 pneumonitis. AIMS This study aims to describe the patient characteristics, flow and outcomes of admissions to the Royal Melbourne Hospital (RMH) COVID-19 RCU (CRCU) during its initial period of operation. METHODS Single-centre retrospective cohort study, all patients admitted to CRCU between 17 September and 10 December 2021 were included in this study. Patient demographics, including comorbidities and limitations of medical treatment, were analysed. Admission source and discharge destination were reviewed. Length of stay was recorded. Finally, in-hospital and CRCU mortality were analysed. RESULTS Ninety-seven patients, comprising 111 admissions, occurred during the study period with median age of 65 years (48% female). Most patients were admitted from and discharged to the ward. Twenty patients died in hospital (21%), with age, 4C score, comorbidity and presence of obstructive lung disease predicting mortality (area under the curve (AUC) 0.85, P < 0.001). Mortality was significantly higher in those over 65 years of age compared to those under 65 (P < 0.001), or those deemed not for intubation compared to those for intubation (P = 0.0019). CONCLUSIONS This study demonstrates the feasibility of operating a CRCU within an Australian tertiary healthcare setting.
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Affiliation(s)
- Emily Ward-Ambler
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Wallbridge
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kasha Singh
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
| | - Alistair Miller
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Renee Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Goldin
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Su Hii
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Gary Hammerschlag
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Megan Rees
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Dell'Olio A, Vocale C, Primavera A, Pisani L, Altavilla S, Roncarati G, Tumietto F, Viale P, Re MC, Lazzarotto T, Nava S, Ranieri VM, Tonetti T. Environmental Contamination by SARS-CoV-2 During Noninvasive Ventilation in COVID-19. Respir Care 2023; 68:1-7. [PMID: 36379641 PMCID: PMC9993510 DOI: 10.4187/respcare.10323] [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: 11/16/2022]
Abstract
BACKGROUND Environmental contamination by SARS-CoV-2 from patients with COVID-19 undergoing noninvasive ventilation (NIV) in the ICU is still under investigation. This study set out to investigate the presence of SARS-CoV-2 on surfaces near subjects receiving NIV in the ICU under controlled conditions (ie, use of dual-limb circuits, filters, adequate room ventilation). METHODS This was a single-center, prospective, observational study in the ICU of a tertiary teaching hospital. Four surface sampling areas, at increasing distance from subject's face, were identified; and each one was sampled at fixed intervals: 6, 12, and 24 h. The presence of SARS-CoV-2 was detected with real-time reverse transcriptase-polymerase-chain-reaction (RT-PCR) test on environmental swabs; the RT-PCR assay targeted the SARS-CoV-2 virus nucleocapsid N1 and N2 genes and the human RNase P gene as internal control. RESULTS In a total of 256 collected samples, none were positive for SARS-CoV-2 genetic material, whereas 21 samples (8.2%) tested positive for RNase P, thus demonstrating the presence of genetic material unrelated to SARS-CoV-2. CONCLUSIONS Our data show that application of NIV in an appropriate environment and with correct precautions leads to no sign of surface environmental contamination. Accordingly, our data support the idea that use of NIV in the ICU is safe both for health care workers and for other patients.
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Affiliation(s)
- Alessio Dell'Olio
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Caterina Vocale
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandra Primavera
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Lara Pisani
- Section of Pneumology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Pulmonology and Respiratory Critical Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Salvatore Altavilla
- Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Roncarati
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Tumietto
- Antimicrobial Stewardship Unit, Metropolitan Department Integrated Management Infectious Risk, AUSL Bologna, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Carla Re
- Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; and Section of Microbiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Nava
- Section of Pneumology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Pulmonology and Respiratory Critical Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - V Marco Ranieri
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Tonetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; and Anesthesia and Intensive Care Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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5
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Dyrbuś M, Oraczewska A, Szmigiel S, Gawęda S, Kluszczyk P, Cyzowski T, Jędrzejek M, Dubik P, Kozłowski M, Kwiatek S, Celińska B, Wita M, Trejnowska E, Swinarew A, Darocha T, Barczyk A, Skoczyński S. Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19. J Clin Med 2022; 11:jcm11112958. [PMID: 35683347 PMCID: PMC9181244 DOI: 10.3390/jcm11112958] [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: 04/10/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 12/16/2022] Open
Abstract
Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65−5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.
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Affiliation(s)
- Maciej Dyrbuś
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland
- Correspondence:
| | - Aleksandra Oraczewska
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Szymon Szmigiel
- Student Scientific Society, Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.S.); (S.G.); (P.K.)
| | - Szymon Gawęda
- Student Scientific Society, Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.S.); (S.G.); (P.K.)
| | - Paulina Kluszczyk
- Student Scientific Society, Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (S.S.); (S.G.); (P.K.)
| | - Tomasz Cyzowski
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- Department of Anaesthesiology and Intensive Therapy, Medical University of Silesia, 40-752 Katowice, Poland
| | - Marek Jędrzejek
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-752 Katowice, Poland
| | - Paweł Dubik
- Department of Anesthesiology and Intensive Therapy, Hospital of the Ministry of the Interior and Administration, 40-061 Katowice, Poland;
| | - Michał Kozłowski
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-752 Katowice, Poland
| | - Sebastian Kwiatek
- Division of Internal Diseases Oncology, Gastroenterology, Angiology, Department of Cardiology Intensive Care, Hospital of the Ministry of the Interior and Administration, 40-061 Katowice, Poland;
| | - Beata Celińska
- Consultant in Infectious Diseases GCM, Upper Silesian Medical Center, 40-635 Katowice, Poland;
| | - Michał Wita
- First Chair and Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Ewa Trejnowska
- Department of Cardiac Anaesthesia and Intensive Care, Silesian Centre for Heart Diseases in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Andrzej Swinarew
- Faculty of Science and Technology, University of Silesia in Katowice, 41-500 Chorzów, Poland;
- Department of Swimming and Water Rescue, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Tomasz Darocha
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- Department of Anaesthesiology and Intensive Therapy, Medical University of Silesia, 40-752 Katowice, Poland
| | - Adam Barczyk
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Szymon Skoczyński
- Pyrzowice Temporary Hospital, Leszek Giec Upper-Silesian Medical Center, 40-635 Katowice, Poland; (A.O.); (T.C.); (M.J.); (M.K.); (T.D.); (S.S.)
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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Kühn L, Esmail A, Oelofse S, Dheda K. A breath of relief: High-flow nasal oxygen in a resource-limited setting. Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i1.223. [PMID: 35647525 PMCID: PMC9132073 DOI: 10.7196/ajtccm.2022.v28i1.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- L Kühn
- Centre for Lung Infection and Immunity, Division of Pulmonology,
Department of Medicine and UCT Lung Institute, University of Cape
Town, South Africa
| | - A Esmail
- Centre for Lung Infection and Immunity, Division of Pulmonology,
Department of Medicine and UCT Lung Institute, University of Cape
Town, South Africa
| | - S Oelofse
- Centre for Lung Infection and Immunity, Division of Pulmonology,
Department of Medicine and UCT Lung Institute, University of Cape
Town, South Africa
| | - K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology,
Department of Medicine and UCT Lung Institute, University of Cape
Town, South Africa
- South African MRC/UCT Centre for the Study
of Antimicrobial Resistance, University of Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection
Biology, London School of Hygiene and Tropical Medicine, UK
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7
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Pettenuzzo T, Giraudo C, Fichera G, Della Paolera M, Tocco M, Weber M, Gorgi D, Carlucci S, Lionello F, Lococo S, Boscolo A, De Cassai A, Pasin L, Rossato M, Vianello A, Vettor R, Sella N, Navalesi P. Chest X-ray Does Not Predict the Risk of Endotracheal Intubation and Escalation of Treatment in COVID-19 Patients Requiring Noninvasive Respiratory Support. J Clin Med 2022; 11:jcm11061636. [PMID: 35329962 PMCID: PMC8950017 DOI: 10.3390/jcm11061636] [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: 02/20/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Forms of noninvasive respiratory support (NIRS) have been widely used to avoid endotracheal intubation in patients with coronavirus disease-19 (COVID-19). However, inappropriate prolongation of NIRS may delay endotracheal intubation and worsen patient outcomes. The aim of this retrospective study was to assess whether the CARE score, a chest X-ray score previously validated in COVID-19 patients, may predict the need for endotracheal intubation and escalation of respiratory support in COVID-19 patients requiring NIRS. From December 2020 to May 2021, we included 142 patients receiving NIRS who had a first chest X-ray available at NIRS initiation and a second one after 48–72 h. In 94 (66%) patients, the level of respiratory support was increased, while endotracheal intubation was required in 83 (58%) patients. The CARE score at NIRS initiation was not predictive of the need for endotracheal intubation (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.96–1.06) or escalation of treatment (OR 1.01, 95% CI 0.96–1.07). In conclusion, chest X-ray severity, as assessed by the CARE score, did not allow predicting endotracheal intubation or escalation of respiratory support in COVID-19 patients undergoing NIRS.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Chiara Giraudo
- Institute of Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Giulia Fichera
- Pediatric Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
| | - Michele Della Paolera
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Martina Tocco
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Michael Weber
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 23 Spitalgasse, 1090 Vienna, Austria;
| | - Davide Gorgi
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Silvia Carlucci
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Federico Lionello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Sara Lococo
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Annalisa Boscolo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Alessandro De Cassai
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Laura Pasin
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Marco Rossato
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Roberto Vettor
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Nicolò Sella
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Correspondence:
| | - Paolo Navalesi
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
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Peng Y, Dai B, Zhao HW, Wang W, Kang J, Hou HJ, Tan W. Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis. Ther Adv Respir Dis 2022; 16:17534666221113663. [PMID: 35861299 PMCID: PMC9340323 DOI: 10.1177/17534666221113663] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/29/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) are important treatment approaches for acute hypoxemic respiratory failure (AHRF) in coronavirus disease 2019 (COVID-19) patients. However, the differential impact of HFNC versus NIV on clinical outcomes of COVID-19 is uncertain. OBJECTIVES We assessed the effects of HFNC versus NIV (interface or mode) on clinical outcomes of COVID-19. METHODS We searched PubMed, EMBASE, Web of Science, Scopus, MedRxiv, and BioRxiv for randomized controlled trials (RCTs) and observational studies (with a control group) of HFNC and NIV in patients with COVID-19-related AHRF published in English before February 2022. The primary outcome of interest was the mortality rate, and the secondary outcomes were intubation rate, PaO2/FiO2, intensive care unit (ICU) length of stay (LOS), hospital LOS, and days free from invasive mechanical ventilation [ventilator-free day (VFD)]. RESULTS In all, 23 studies fulfilled the selection criteria, and 5354 patients were included. The mortality rate was higher in the NIV group than the HFNC group [odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.51-0.84, p = 0.0008, I2 = 60%]; however, in this subgroup, no significant difference in mortality was observed in the NIV-helmet group (OR = 1.21, 95% CI: 0.63-2.32, p = 0.57, I2 = 0%) or NIV-continuous positive airway pressure (CPAP) group (OR = 0.77, 95% CI: 0.51-1.17, p = 0.23, I2 = 65%) relative to the HFNC group. There were no differences in intubation rate, PaO2/FiO2, ICU LOS, hospital LOS, or days free from invasive mechanical ventilation (VFD) between the HFNC and NIV groups. CONCLUSION Although mortality was lower with HFNC than NIV, there was no difference in mortality between HFNC and NIV on a subgroup of helmet or CPAP group. Future large sample RCTs are necessary to prove our findings. REGISTRATION This systematic review and meta-analysis protocol was prospectively registered with PROSPERO (no. CRD42022321997).
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Affiliation(s)
- Yun Peng
- Department of Intensive Care Medicine, The
Second Hospital of Jiaxing, Jiaxing, China
| | - Bing Dai
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Hong-wen Zhao
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Wei Wang
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Jian Kang
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Hai-jia Hou
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University,
Shenyang, China
| | - Wei Tan
- Department of Respiratory and Critical Care
Medicine, The First Affiliated Hospital of China Medical University, No.
155, Nanjing North Street, Heping District, Shenyang 110001, China
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