scholarly journals The impact of high dose oral cotrimoxazole in patients with COVID-19 with hypoxic respiratory failure requiring non-invasive ventilation: A Case Control Study

2021 ◽  
Author(s):  
Saurabh Singh ◽  
Thomas John ◽  
Prashant Kumar ◽  
Syed Rehan Quadery
Keyword(s):  
Critical Care ◽  
Respiratory Failure ◽  
Standard Therapy ◽  
High Dose ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Dose Oral ◽  
Hypoxic Respiratory Failure ◽  
The Impact

ABSTRACTBackgroundCOVID-19 can be fatal in a significant proportion of people who develop critical illness, resulting in hypoxic respiratory failure secondary to Acute Respiratory Distress Syndrome (ARDS) which is thought to be mediated by a cytokine storm syndrome. Steroids have been shown to be of some benefit, but the mainstay of treatment remains supportive.MethodsThe data was collected retrospectively from consecutive, newly diagnosed patients presenting to the critical care facility of I Q City Medical College Hospital, Durgapur, India between June and November 2020 with critical COVID-19 on non-invasive ventilation treated with high dose oral cotrimoxazole (CTX) in addition to standard therapy (ST) and compared with patients with critical COVID-19 receiving standard therapy alone.Results201 patients were identified. Of which 151 patients received CTX in addition to ST (mean age ± SD 59 ± 13 years, 81% male and mean BMI ± SD 28 ± 2) and 50 patients received ST alone (mean age ± SD 63 ± 12, 64% male and mean BMI ± SD 27 ± 2). We observed that the patients with critical COVID-19 receiving CTX in addition to ST had significantly better outcomes including reduced in-patient mortality (13% versus 40%, p <0.001), length of hospital and critical care unit stay (mean, 11 versus 15 days (p <0.001) and 6 versus 11 days (p <0.001) respectively), and the need for mechanical ventilation (16% versus 42%, p <0.001) with improved CRP at day 7 (mean, 38mg/L versus 62mg/L, p = 0.001).ConclusionThese results may be due to the antibiotic and anti-cytokine effects of CTX. Clinical trials are currently underway to test our observations.

scholarly journals Effectiveness of non-invasive positive pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease

2018 ◽  
Vol 5 (2) ◽  
pp. 102 ◽  
Author(s):  
Bhavani Mohan Raju ◽  
Sushma Jotkar ◽  
Prathyusha M. ◽  
Shraddha Goswami ◽  
Mukesh Dube ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Exacerbation ◽  
Standard Therapy ◽  
Clinical Status ◽  
Invasive Ventilation ◽  
Hypercapnic Respiratory Failure ◽  
Acute Exacerbation Of Copd ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Exacerbation Of Copd

<p class="abstract"><strong>Background:</strong> In patients with acute exacerbations of COPD, endotracheal intubation and complications associated with mechanical ventilation may be evaded using non-invasive ventilation.<strong> </strong>The aim of the study was to analyse the effectiveness of NPPV for hypercapnic respiratory failure secondary to acute exacerbation of COPD in India.</p><p class="abstract"><strong>Methods:</strong> In this prospective study, 63 cases of hypercapnic respiratory failure secondary to acute exacerbation of COPD admitted in the intensive care unit during 2011-13 formed the study population. Standard therapy was initiated in all the patients. Patients who failed to improve with standard therapy alone were given a trial of non invasive ventilation. Non invasively ventilated patients, showing significantly improvement in their clinical status and arterial blood gas parameters were discharged. Patients who failed to show significant improvement with NPPV were given invasive ventilation.</p><p class="abstract"><strong>Results:</strong> Standard therapy was initiated in 63 patients on admission but 25 patients failed to improve with standard therapy alone. Out of the total 25 patients non invasively ventilated, 22 patients showed significantly improvement. Significant improvement in the Mean pH, Mean paCO2 and Mean paHCO3 in both standard therapy and non invasive ventilation group. Success rate was found to be highest (88%) in standard therapy + noninvasive ventilation treatment modality group.</p><p class="abstract"><strong>Conclusions: </strong>NIV is an effective tool in hypercapnic respiratory failure secondary to acute exacerbation of COPD and its early initiation would improve the clinical status and respiratory acidosis.</p>

scholarly journals Effectiveness and applicability of Non-Invasive Ventilation (NIV) in the Emergency Department in acute respiratory failure due to Sars-CoV-2 pneumonia

2020 ◽  
Vol 16 (2) ◽  
Author(s):  
Federico Lari ◽  
Fabrizio Giostra ◽  
Stefania Guerrini
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
De Novo ◽  
Correct Identification ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Radiological Features ◽  
Non Invasive Ventilation ◽  
Hypoxic Respiratory Failure

Treatment of de novo acute hypoxic respiratory failure is not recommended by current Non-Invasive Ventilation (NIV) guidelines as it does not seem to improve patients outcome. Many cases of acute hypoxic respiratory failure associated with Sars-Cov2 infection (SARI) have been observed during Sars-Cov2 pandemic. So far, data are missing regarding the use of NIV, but a correct identification of subgroups of patients based on different clinical, patho-physiological and radiological features, might be helpful for stratifying patients and choosing the correct respiratory support (invasive versus non-invasive). In case of NIV appliance, risk of environmental virus dispersion is particularly elevated; therefore, extreme attention by operators is required.

scholarly journals The role of non-invasive ventilation in the management of type II respiratory failure in patients with myotonic dystrophy

2021 ◽  
pp. 00192-2020
Author(s):  
V. Rautemaa ◽  
M. E. Roberts ◽  
A. Bentley ◽  
T. W. Felton
Keyword(s):  
Respiratory Failure ◽  
Myotonic Dystrophy ◽  
Type Ii ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Obstructive Sleep ◽  
Set Up ◽  
The Impact

Type 1 myotonic dystrophy (DM1) causes sleep disordered breathing and respiratory failure due to a combination of obstructive sleep apnoea, reduced central drive and respiratory muscle weakness. Non-invasive ventilation (NIV) is commonly used for treating respiratory failure in neuromuscular disease, however, there have been few studies assessing the role of NIV in DM1. The aim of this retrospective service evaluation was to investigate the impact of NIV adherence on hypercapnia and symptoms of hypoventilation in patients with DM1. Data on capillary pCO2, lung function, adherence to NIV and symptoms of hypoventilation were obtained from the records of 40 patients with DM1. Mean capillary pCO2 significantly reduced from 6.81±1.17 kPa during supervised inpatient set-up to 5.93±0.82 kPa after NIV set-up (p<0.001). NIV adherence reduced from 7.8 (range: 1.0–11.0) h/24 h during supervised inpatient set-up to 2.9 (0–10.4) h/24 h in the community. Overall 72% of patients used NIV <5/24 h during follow-up, including 11% who discontinued NIV completely. There was no correlation between adherence to NIV and changes in capillary pCO2. Patients who reported symptomatic benefit (50%) had higher adherence than those who did not feel benefit (p<0.05). In conclusion, in patients with Myotonic Dystrophy with type II respiratory failure maintaining adherence is challenging.

scholarly journals Conscious prone positioning during non-invasive ventilation in COVID-19 patients: experience from a single centre

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 859
Author(s):  
Helmi C. Burton-Papp ◽  
Alexander I. R. Jackson ◽  
Ryan Beecham ◽  
Matteo Ferrari ◽  
Myra Nasim-Mohi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Invasive Mechanical Ventilation ◽  
Prone Positioning ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Hypoxic Respiratory Failure ◽  
Patients Experience ◽  
Adequate Oxygenation

Critically ill patients admitted to hospital following SARS-CoV-2 infection often experience hypoxic respiratory failure and a proportion require invasive mechanical ventilation to maintain adequate oxygenation. The combination of prone positioning and non-invasive ventilation in conscious patients may have a role in improving oxygenation. The purpose of this study was to assess the effect of prone positioning in spontaneously ventilating patients receiving non-invasive ventilation admitted to the intensive care.  Clinical data of 81 patients admitted with COVID 19 pneumonia and acute hypoxic respiratory failure were retrieved from electronic medical records and examined. Patients who had received prone positioning in combination with non-invasive ventilation were identified. A total of 20 patients received prone positioning in conjunction with non-invasive ventilation. This resulted in improved oxygenation as measured by a change in PaO2/FiO2 (P/F) ratio of 28.7 mmHg while prone, without significant change in heart rate or respiratory rate. Patients on average underwent 5 cycles with a median duration of 3 hours. There were no reported deaths, 7 of the 20 patients (35%) failed non-invasive ventilation and subsequently required intubation and mechanical ventilation. In our cohort of 20 COVID-19 patients with moderate acute hypoxic respiratory failure, prone positioning with non-invasive ventilation resulted in improved oxygenation. Prone positioning with non-invasive ventilation may be considered as an early therapeutic intervention in COVID-19 patients with moderate acute hypoxic respiratory failure.

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