P275 Course of COVID-19 in patients with Inflammatory Bowel Diseases treated with biologics: the Israeli experience

Abstract Background Biologic treatments are inherently associated with an increased risk of infections, and recipients are intuitively considered at-risk for a more severe course of COVID-19. However, the actual risks are not fully described, neither are the appropriate adjustments needed to mitigate such risks. Methods Nation-wide registry was set up by Israeli IBD Section, to characterize course of COVID-19 in IBD patients who contacted SARS-CoV-2 infection while on biologics. We prospectively collected demographic and clinical data, and analyzed COVID-19 outcomes with regard to the specific treatments. Results Between Apr and Oct 2020, 144 patients with an established IBD diagnosis and confirmed COVID-19 were enrolled at 20 IBD referral centers. The majority of patients was under the age of 40 (113, 78%), 9 (6%) were younger than 18, only 4 patients (3%) over the age of 70. 94 patients received biologics, as monotherapy (76, 52.8%), combined with immunomodulators (9, 10%) or concomitant corticosteroids (9, 10%). 37 patients (26%) were reported with moderate and severe COVID-19 course, third of them (13) on biologics. 24 patents (17%) were admitted for hospitalization, the rest managed in home setting (114, 79%) and hotels converted into makeshift healthcare facilities (6, 4%). Fifteen patients (10%) required non-invasive ventilation and oxygen support, 3 patients (2%) went on mechanical ventilation. All patients recovered uneventfully, with no mortalities reported. Age was the most significant factor associated with moderate and severe disease. We found no correlation between bowel disease activity and the severity of COVID-19 course. The rate of serious COVID-19 for the 94 patients who had received biologics was significantly lower than that of 50 patients who were not treated with biologics (13/94 vs 24/50; RR 0.29 [95% CI, 0.161–0.515]; p < 0.0001). On adjusting for age, gender, comorbidities, IBD phenotype and activity, the surprising ameliorating effect associated with biologics was profound and significant (OR, 0.082 [95% CI 0.009-0.621], p =0.013) in all age categories. Conclusion Our results are reassuring and encouraging, and do not suggest that therapeutic immune suppression renders IBD patients particularly vulnerable for more severe course of the COVID-19. Adjusted odds for severe COVID-19 course actually decreased significantly in patients treated with biologics. It could be speculated that cytokine inhibition may mitigate progression of the infection to a devastating hyperinflammatory state. Continuing necessary maintenance immune suppression seems to be appropriate and safe approach, despite the COVID-19 pandemic.

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Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

Italian Journal of Medicine ◽

10.4081/itjm.2017.675 ◽

2017 ◽

Vol 11 (1) ◽

pp. 57

Author(s):

Enrico Cinque ◽

Ines Maria Grazia Piroddi ◽

Cornelius Barlascini ◽

Alessandro Perazzo ◽

Antonello Nicolini

Keyword(s):

Mechanical Ventilation ◽

Severe Disease ◽

Invasive Mechanical Ventilation ◽

Clinical Signs ◽

Case Series ◽

Community Acquired Pneumonia ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by <em>Streptococcus pneumoniae</em> was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible <em>Staphylococcus aureus</em> co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.

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Non-Invasive Ventilatory Strategies to Decrease Bronchopulmonary Dysplasia—Where Are We in 2021?

Children ◽

10.3390/children8020132 ◽

2021 ◽

Vol 8 (2) ◽

pp. 132

Author(s):

Vikramaditya Dumpa ◽

Vineet Bhandari

Keyword(s):

Lung Injury ◽

Bronchopulmonary Dysplasia ◽

Premature Infants ◽

Extremely Low Birth Weight ◽

Positive Pressure ◽

Invasive Ventilation ◽

Clinical Practices ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk

Recent advances in neonatology have led to the increased survival of extremely low-birth weight infants. However, the incidence of bronchopulmonary dysplasia (BPD) has not improved proportionally, partly due to increased survival of extremely premature infants born at the late-canalicular stage of lung development. Due to minimal surfactant production at this stage, these infants are at risk for severe respiratory distress syndrome, needing prolonged ventilation. While the etiology of BPD is multifactorial with antenatal, postnatal, and genetic factors playing a role, ventilator-induced lung injury is a major, potentially modifiable, risk factor implicated in its causation. Infants with BPD are at a higher risk of developing complications including sepsis, pulmonary arterial hypertension, respiratory failure, and death. Long-term problems include increased risk of hospital readmissions, respiratory infections, and asthma-like symptoms during infancy and childhood. Survivors who have BPD are also at increased risk of poor neurodevelopmental outcomes. While the ultimate solution for avoiding BPD lies in the prevention of preterm births, strategies to decrease its incidence are the need of the hour. It is time to focus on gentler modes of ventilation and the use of less invasive surfactant administration techniques to mitigate lung injury, thereby potentially decreasing the burden of BPD. In this article, we discuss the use of non-invasive ventilation in premature infants, with an emphasis on studies showing an effect on BPD with different modes of non-invasive ventilation. Practical considerations in the use of nasal intermittent positive pressure ventilation are also discussed, considering the significant heterogeneity in clinical practices and management strategies in its use.

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P201 A remote pathway for inpatient home non-invasive ventilation set-up

10.1136/thorax-2018-212555.358 ◽

2018 ◽

Author(s):

L Flight ◽

S Dixon ◽

B Khan ◽

R Bhalla ◽

H Aminy-Raouf ◽

...

Keyword(s):

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Set Up

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Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review

Medical Sciences ◽

10.3390/medsci7010010 ◽

2019 ◽

Vol 7 (1) ◽

pp. 10 ◽

Cited By ~ 2

Author(s):

Nicolò Maria Vanoni ◽

Manuela Carugati ◽

Noemi Borsa ◽

Giovanni Sotgiu ◽

Laura Saderi ◽

...

Keyword(s):

Systematic Review ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Community Acquired Pneumonia ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk ◽

Severity Scores ◽

Ventilatory Management

Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles—of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.

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How to set up an acute non-invasive ventilation service

Non-invasive Ventilation and Weaning: Principles and Practice ◽

10.1201/b13434-18 ◽

2010 ◽

pp. 109-118

Keyword(s):

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Set Up

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Trends in oxygen therapy in patients with moderate to severe COVID-19 admitted to the ICU

Indian Journal of Clinical Anaesthesia ◽

10.18231/j.ijca.2021.098 ◽

2021 ◽

Vol 8 (4) ◽

pp. 10-14

Author(s):

Raghunath S S ◽

Bheema Devanand ◽

Mohammed Nizamuddeen B ◽

Bala Bhaskar S ◽

Pradnya Kothari ◽

...

Keyword(s):

Oxygen Therapy ◽

Prospective Observational Study ◽

Severe Disease ◽

Comfort Level ◽

Chi Square ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Chi Square Test ◽

Polymerase Chain ◽

Ethical Clearance

The most concerning complication of severe acute respiratory syndrome corona virus 2 (SARSCoV-2) pneumonia is acute hypoxemic failure. Though various antivirals, steroids, immunomodulators have been tried, oxygen therapy remains the mainstay of treatment. After obtaining institutional ethical clearance, a prospective observational study was conducted on 102 COVID-19 positive patients aged 20 years and above, admitted in the ICU with moderate to severe disease. COVID-19 infection was confirmed by polymerase chain reaction or rapid antigen test. Data of two demographically comparable groups i.e., patients on HFNO and NIV was analysed outcome was defined as discharge from ICU, shift to other non-invasive modes of oxygen therapy, endotracheal intubation or death, and comfort level for each mode. The data was analysed using SPSS-16.0, Chi-square test and “t” value test were applied.Comparison ofthe mean number of invasive ventilator free days of HFNO and NIV was insignificant(p>0.05). Among the patients on HFNO (high flow nasal oxygen) 49.09% were stepped down to NRB (non-rebreathing mask) whereas 7.27% went for intubation which is significant compared to NIV mask (non-invasive ventilation), where 13.64% were stepped down to HFNO and 34.09% were intubated (p=0.000).Oxygen therapy with HFNO is associated with better outcome and less mortality when compared with NIV.

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