Modified Brixia chest X‐ray severity scoring system and correlation with intubation, non‐invasive ventilation and death in a hospitalised COVID‐19 cohort

Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of COVID-19. The scoring system was established by weighting the ventilator performance on five different aspects: the stability of pressurization, response to leaks alteration, performance of reaction, volume delivery, and accuracy in oxygen delivery. The weighting factors were determined with analytic hierarchy process (AHP). Survey was sent out to 66 clinical and mechanical experts. The scoring system was built based on 54 valid replies. A total of 12 commercially available ICU ventilators providing non-invasive ventilation were evaluated using the novel scoring system. A total of eight ICU ventilators with non-invasive ventilation mode and four dedicated non-invasive ventilators were tested according to the scoring system. Four COVID-19 phenotypes were simulated using the ASL5000 lung simulator, namely (1) increased airway resistance (IR) (10 cm H2O/L/s), (2) low compliance (LC) (compliance of 20 ml/cmH2O), (3) low compliance plus increased respiratory effort (LCIE) (respiratory rate of 40 and inspiratory effort of 10 cmH2O), (4) high compliance (HC) (compliance of 50 ml/cmH2O). All of the ventilators were set to three combinations of pressure support and positive end-expiratory pressure levels. The data were collected at baseline and at three customized leak levels. Significant inaccuracies and variations in performance between different non-invasive ventilators were observed, especially in the aspect of leaks alteration, oxygen and volume delivery. Some ventilators have stable performance in different simulated phenotypes whereas the others have over 10% scoring differences. It is feasible to use the proposed scoring system to evaluate the ventilator performance. In the COVID-19 pandemic, clinicians should be aware of possible strengths and weaknesses of ventilators.

Download Full-text

Metastatic pulmonary dissemination as differential diagnosis of COVID-19 disease

BMJ Case Reports ◽

10.1136/bcr-2020-237453 ◽

2020 ◽

Vol 13 (10) ◽

pp. e237453

Author(s):

Cristel Perdigón Martinelli ◽

Carlos Morell ◽

Carolina González ◽

Cristina Nova-Lozano

Keyword(s):

Bone Lesions ◽

Serological Tests ◽

Intensive Care Admission ◽

X Ray ◽

Non Invasive ◽

Reverse Transcription Pcr ◽

Inflammatory Status ◽

Non Invasive Ventilation ◽

Chest X Ray ◽

Diagnostic Investigations

A 13-year-old boy presented to hospital with 3-day self-limited fever, followed by dry cough, persistent asthenia and impaired general condition of 2 weeks’ duration. Blood analyses showed a severe inflammatory status and chest X-ray images were consistent with bilateral COVID-19 pneumonia. He developed an acute respiratory failure that required paediatric intensive care admission and non-invasive ventilation. A targeted COVID-19 treatment was initiated with hydroxicloroquine, corticosteroids, enoxaparine and a single dose of tocilizumab. Repeated serological tests and real-time reverse transcription PCR for SARS-CoV-2 were negative. Other infectious pathogens were also ruled out. Thoracic high resolution CT showed an intense bilateral pulmonary dissemination with lytic vertebral bone lesions. After diagnostic investigations, Ewing’s sarcoma with metastatic pulmonary dissemination was diagnosed. Nowadays, in the context of SARS-CoV-2 community pandemic, we cannot forget that COVID-19 clinical presentation is not specific and other entities can mimic its clinical features.

Download Full-text

994 Non-Invasive Ventilation (NIV) in Children - Establishment of a Pediatric NIV Scoring System

Archives of Disease in Childhood ◽

10.1136/archdischild-2012-302724.0994 ◽

2012 ◽

Vol 97 (Suppl 2) ◽

pp. A284-A284

Author(s):

K. Bohn ◽

S. Gehring ◽

R. Huth ◽

C. Martin

Keyword(s):

Scoring System ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Download Full-text

Utilisation of RAM cannula for non-invasive respiratory support for infants in the cardiac ICU

Cardiology in the Young ◽

10.1017/s1047951121001062 ◽

2021 ◽

pp. 1-7

Author(s):

Ashish Saini ◽

Kevin O. Maher ◽

Shriprasad R. Deshpande

Keyword(s):

Ventilatory Support ◽

Respiratory Support ◽

Pulmonary Insufficiency ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Additional Burden ◽

Chest X Ray ◽

One Year

Abstract Background: Children with CHD carry an additional burden of pulmonary insufficiency, often necessitating prolonged ventilatory support, especially in the peri-operative phase. There has been an increase in the utilisation of non-invasive ventilatory support for these children. The objective of this study was to evaluate the utilisation, safety, and outcomes of RAM cannula as a tool for escalation and de-escalation of respiratory support in paediatric cardiac patients less than one year of age. Methods: A single-centre retrospective cohort study of patients supported with RAM cannula. Results: A total of 275 instances of RAM use were included in the study, 81.1% being post-operative. Patients were stratified into escalation and de-escalation cohorts based on the indication of non-invasive ventilation. The success rate of using RAM cannula was 69.5% overall, 66.1% in the escalation group, and 72.8% in the de-escalation group. At baseline, age at cardiac ICU admission >30 days, FiO2 ≤ 40%, PaCO2 ≤ 50 mmHg; and after 12 hours of non-invasive ventilation support respiratory rate ≤ 60/min, PaO2 ≥ 50 mmHg, PaCO2 ≤ 50 mmHg; and absence of worsening on follow-up chest X-ray predicted the success with a sensitivity of 95% in the logistic regression model. Successful support was associated with a significantly shorter unit stay. Conclusions: RAM cannula can be safely used to provide non-invasive support to infants in the cardiac ICU for escalation and de-escalation of respiratory support. Factors associated with success can be used to make decisions about candidacy and appropriate timing of non-invasive ventilation use to maximise effectiveness.

Download Full-text