scholarly journals CPAP delivered outside critical care during the second wave of COVID-19: outcomes from a UK respiratory surge unit

2021 ◽  
Vol 8 (1) ◽  
pp. e000907
Author(s):  
Rebecca Nightingale ◽  
Joseph Lewis ◽  
Katelyn Rhiannon Monsell ◽  
Lewis Jones ◽  
Christopher Smith ◽  
...  
Keyword(s):  
Critical Care ◽  
Respiratory Failure ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
Pulmonary Barotrauma ◽  
Care Environment ◽  
Non Invasive ◽  
Retrospective Cohort Analysis ◽  
Second Wave

BackgroundNHS England recommends non-invasive continuous positive airway pressure (CPAP) as a possible treatment for type 1 respiratory failure associated with COVID-19 pneumonitis, either to avoid intubation or as a ceiling of care. However, data assessing this strategy are sparse, especially for the use of CPAP as a ceiling of care, and particularly when delivered outside of a traditional critical care environment. We describe a cohort of patients from Liverpool, UK, who received CPAP on a dedicated respiratory surge unit at the start of the second wave of the COVID-19 pandemic in UK.MethodsRetrospective cohort analysis of consecutive patients receiving CPAP for the treatment of respiratory failure secondary to COVID-19 on the respiratory surge unit at the Royal Liverpool Hospital, Liverpool, UK from 21 September until 30 November 2020.Results88 patients were included in the analysis. 56/88 (64%) were deemed suitable for escalation to invasive mechanical ventilation (IMV) and received CPAP as a trial; 32/88 (36%) received CPAP as a ceiling of care. Median age was 63 years (IQR: 56–74) and 58/88 (66%) were men. Median SpO2/FiO2 immediately prior to CPAP initiation was 95 (92–152). Among patients for escalation to IMV, the median time on CPAP was 6 days (IQR 4–7) and survival at day 30 was 84% (47/56) with 14/56 (25%) escalated to IMV. Of those patients for whom CPAP was ceiling of care, the median duration of CPAP was 9 days (IQR 7–11) and 18/32 (56%) survived to day 30. Pulmonary barotrauma occurred in 9% of the cohort. There were no associations found on multivariant analysis that were associated with all-cause 30-day mortality.ConclusionsWith adequate planning and resource redistribution, CPAP may be delivered effectively outside of a traditional critical care setting for the treatment of respiratory failure due to COVID-19. Clinicians delivering CPAP to patients with COVID-19 pneumonitis should be alert to the dangers of pulmonary barotrauma. Among patients who are for escalation of care, the use of CPAP may avoid the need for IMV in some patients. Our data support the NHS England recommendation to consider CPAP as a ceiling of care.

scholarly journals ROX Index Predicts Intubation in Patients with COVID-19 Pneumonia and Moderate to Severe Hypoxemic Respiratory Failure Receiving High Flow Nasal Therapy. (Preprint)

2021 ◽  
Author(s):  
Maulin Patel ◽  
Junad Chowdhury ◽  
Nicole Mills ◽  
Robert Marron ◽  
Andrew Gangemi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
Group Versus ◽  
High Flow ◽  
University Hospital ◽  
Hypoxemic Respiratory Failure ◽  
Temple University ◽  
Pulmonary Vasodilators ◽  
Retrospective Cohort Analysis

BACKGROUND Use of high flow nasal therapy (HFNT) to treat COVID-19 pneumonia has been greatly debated around the world due to concern for increased healthcare worker transmission and delays in invasive mechanical Ventilation (IMV). Herein we analyze the utility of the noninvasive ROX index to predict the need and timing for IMV. OBJECTIVE Can ROX index be used to predict the need for intubation in patients with COVID-19 related Hypoxemic Respiratory Failure receiving High flow Nasal Therapy? METHODS Design This was a retrospective cohort analysis of 129 consecutive patients with COVID-19 admitted to Temple University Hospital in Philadelphia, Pennsylvania, from March 10, 2020, to May 17, 2020. Setting The study was a single center study conducted in COVID units (ICU and floors) at Temple University Hospital Participants Patients with moderate to severe hypoxemic respiratory failure treated with High Flow nasal therapy (HFNT) were included in the study. HFNT patients were divided into two groups: HFNT only and HFNT progressed to IMV. Primary outcomes The primary outcome was the ability of the ROX index to predict the need of IMV. Secondary outcomes were mortality, rates of intubation, length of stay (LOS) and rates of nosocomial infections in our cohort treated with HFNT were also reported. RESULTS Of the 837 patients with COVID-19, 129 met inclusion criteria. The mean age was 60.8 (+13.6) years, BMI 32.6 (+8), 58 (45 %) were female, 72 (55.8%) were African American, 40 (31%) Hispanic. 48 (37.2%) were smokers. Mean time to intubation was 2.5 days (+ 3.3). ROX index of less than 5 at HFNT initiation was predictive of progression to IMV (OR = 2.137, p = 0,052). Any decrease in ROX index after HFNT initiation was predictive of intubation (OR= 14.67, p <0.0001). Mortality was 11.2% in HFNT only group versus 47.5% in the HFNT progressed to IMV group (p,0.0001). Mortality and need for pulmonary vasodilators were higher in the HNFT progressed to IMV group. CONCLUSIONS ROX helps predicts need for IMV and thus limiting morbidity and mortality associated with IMV. CLINICALTRIAL NA

scholarly journals Use of non-invasive ventilation in motor neuron disease – a retrospective cohort analysis

2021 ◽  
Vol 18 ◽  
pp. 147997312110638
Author(s):  
Laura J Walsh ◽  
Kevin F Deasy ◽  
Fernando Gomez ◽  
Elizabeth O’Sullivan ◽  
Joseph Eustace ◽  
...  
Keyword(s):  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Neurodegenerative Disorder ◽  
Cohort Analysis ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Progressive Muscle Weakness ◽  
Non Invasive Ventilation ◽  
Retrospective Cohort Analysis ◽  
Bulbar Onset

Motor neuron disease (MND) is a neurodegenerative disorder which leads to progressive muscle weakness including respiratory muscle decline. The introduction of non-invasive ventilation (NIV) has been shown to improve quality of life, survival and slow the rate of pulmonary function decline. A retrospective chart analysis of patients who attended the MND clinic from 2014 to 2019 at a tertiary-referral, academic, teaching hospital was carried out to evaluate if NIV and greater compliance with NIV was associated with improved survival. 111 patients were included. The mean age at diagnosis was 63.8 years and 61.3% were males. 66.7% of our cohort used NIV and of this 66.7%, 44.1% were compliant. There was a significantly longer survival in those who used NIV ( p = 0.002) and in those who used NIV optimally ( p = 0.02) when both groups were compared to those who did not use NIV. In the bulbar MND group those who were compliant with NIV survived longer than who those who did not use NIV ( p = 0.001). We found a significantly longer survival with the use of NIV, the use of NIV optimally and with use of NIV in those with bulbar onset MND compared to those who did not use NIV.

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