Non-invasive ventilation improves peripheral oxygen saturation and reduces fatigability of quadriceps in patients with COPD

Background: Moving away from invasive ventilation towards timed position change and non-invasive ventilation is especially of benefit in low and middle income countries, where judicious use of the available healthcare resources is the need of the day. Our study was conducted prospectively to develop strategies for non-invasive ventilation in combination with timed position change of patients to see its impact on their outcome.Objectives: Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury. The objective of this prospective, cross sectional study was to develop a protocol for the use of non-invasive ventilation with timed position change to improve COVID-19 patients’ outcomes in the Emergency Department (ED). Methods: All patients presenting with confirmed or suspected COVID-19 were enrolled in the study from March 2020 to October 2020. Data was collected to see the effect of timed position change and non-invasive ventilation on these patients and its effect on delaying or avoiding invasive ventilation. Results: Of the 207 COVID-19 patients presenting to the IHHN ED, 109(52.7%) had oxygen saturation in the nineties in supine position followed by right lateral in 37(17.9%), sitting up in 30(14.5%), left lateral in 29(14%) and prone position in 2(1%). Maximal oxygenation was achieved with non rebreather mask (NRM) and nasal prongs in 87(42%) of the patients, followed by the use of continuous positive airway pressure (CPAP) in 29(14%). Conclusion: Most of the patients preferred to stay in the supine position and described it as the position of comfort. When used in combination supine position, patients on NRM with nasal prongs and on CPAP, had oxygen saturation in the nineties. Central obesity was found to be the prime reason for the inability to prone our patients. This needs to be followed up in the current fourth wave of COVID-19 to see the effectiveness of the said modalities. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5772 How to cite this:Ali S, Khatri A, Ghouri N, Mukhtar S, Zawawi S, Saleem SG. Combining Non-invasive Ventilation with timed position change in the Emergency Department to improve oxygenation and outcomes in patients with COVID-19: A prospective analysis from a low resource setup. Pak J Med Sci. 2022;38(2):375-379. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5772 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Improving Home Oxygen Therapy In Patients With Interstitial Lung Diseases (ILDs): Application Of A Portable Non-Invasive Ventilation (NIV) Device

10.21203/rs.3.rs-21270/v1 ◽

2020 ◽

Author(s):

Sandra Cuerpo ◽

Maria Palomo ◽

Fernanda Hernández-González ◽

Joel Francesqui ◽

Nuria Albacar ◽

...

Keyword(s):

Oxygen Saturation ◽

Exercise Tolerance ◽

Oxygen Therapy ◽

Arterial Oxygen Saturation ◽

Respiratory Muscles ◽

Interstitial Lung Diseases ◽

Arterial Oxygen ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation

Abstract Background: Proper adjustment of arterial oxygen saturation (SaO2) during daily activities in interstitial lung disease (ILD) patients requiring long-term oxygen therapy (LTOT) is challenging. Given the multifactorial nature of the limited exercise tolerance in patients with ILDs, the isolated use of oxygen therapy may not be enough. As demonstrated previously in COPD patients, the use of a portable non-invasive ventilation (NIV) device combined with oxygen therapy may prevent the falling of oxygen saturation during exercise, due to an increased activation of respiratory muscles that could lead to an improvement of exercise tolerance. We sought to assess in patients diagnosed with ILD who are in need of oxygen therapy, the effect of associating a portable NIV to improve oxygen parameters and the distance covered during the 6 minutes walking test (6MWT).Methods: We conducted a prospective observational study in patients with ILDs. After a clinical characterization, we performed 6MWT in two different situations: using a portable oxygen concentrator with the regular flow used by the patient during their daily life activities and afterwards adding the additional support of a NIV. The oxygen saturation parameters were registered with a portable oximeter. Results: We included 16 patients with different ILDs who have oxygen therapy prescribed. The use of NIV associated with oxygen therapy in comparison with the use of oxygen therapy alone showed an increase of the average SaO2 [91% (88-93) vs 88% (86-90); p=0.0005] and a decrease in the percentage of time with oxygen saturation<90% (CT90): 36% (6-56) vs 58% (36-77); p<0.0001. There were no changes in the 6MWT distance: 307m (222-419) vs 316m (228-425); p=0.10Conclusions: In our study the use of a portable NIV system associated with LTOT during exercise showed benefitial effects, especially improvement of oxygen saturation.

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