scholarly journals 22 What can we learn from patients who died from SARS-CoV2 following escalation to a respiratory high dependency unit for trial of non-invasive respiratory Support?

2021 ◽  
Author(s):  
Richard Shoulder ◽  
Sarah Evans ◽  
Patrick Elder ◽  
Anand Sundaralingam ◽  
Namrata Kewalramani ◽  
...  
Keyword(s):  
Respiratory Support ◽  
High Dependency Unit ◽  
Non Invasive ◽  
High Dependency

scholarly journals Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU

2017 ◽  
Vol 16 (3) ◽  
pp. 115-122
Author(s):  
Christopher John Wright ◽  
◽  
Russell Morton Allan ◽  
Stuart A Gillon ◽  
◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Key Management ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
High Dependency Unit ◽  
Non Invasive ◽  
High Dependency ◽  
Threatening Condition ◽  
Life Threatening

Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.

scholarly journals A short course of prednisolone in patients with moderate Covid 19 respiratory failure- stop the progression a case series.

2021 ◽  
Author(s):  
Dale Ventour ◽  
Rheana Sieunarine ◽  
Chavin Gopaul
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Medical Center ◽  
Case Series ◽  
Signs And Symptoms ◽  
Respiratory Support ◽  
High Dependency Unit ◽  
Supplementary Oxygen ◽  
Non Invasive ◽  
High Dependency

Abstract Introduction This case series outlines the results of using prednisolone in patients with moderated respiratory failure secondary to Covid 19 pneumonitis to prevent the progression to invasive ventilation. There is no consensus on the use of prednisolone in Moderate Covid respiratory failure early in the pandemic this should be an additional option where Dexamethasone is not available. Consent was obtained by the patients for anonymous publication of their data.Clinical Findings The author provides evidence of four (4) Covid 19 positive cases admitted to the High dependency Unit with moderate respiratory failure, defined as needing supplementary oxygen therapy to maintain saturations above 90%, who when treated with prednisolone rapidly decreased their oxygen requirement and were successfully weaned to room air within 72 hours of initiation of steroids.Diagnosis Four (4) patients admitted to the High Dependency Unit diagnosed with moderate respiratory failure secondary to PCR positive Covid 19.Intervention Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15-30mg until they were weaned to room air maintaining saturations >95%.Outcome Rapid resolution of worsening respiratory function of Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms which none of them had.Conclusion Initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.

scholarly journals Prolonged non-invasive respiratory support in a COVID-19 patient with severe acute hypoxemic respiratory failure

2021 ◽  
Author(s):  
Andrea Lanza ◽  
Maurizio Sommariva ◽  
Sara Mariani ◽  
Gabriela Ferreyra ◽  
Giuliana Enrica Stagni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Low Flow ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
High Dependency ◽  
Non Invasive Ventilation ◽  
Experienced Team

A pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 was declared in 2020. Severe cases were characterized by the development of acute hypoxemic respiratory failure (AHRF) requiring advanced respiratory support. However, intensive care units (ICU) were saturated, and many patients had to be treated out of ICU. This case describes a 75-year-old man affected by AHRF due to Coronavirus Disease 2019 (COVID-19), hospitalized in a high-dependency unit, with PaO2/FiO2 <100 for 28 consecutive days. An experienced team with respiratory physiotherapists was in charge of the noninvasive ventilatory support (NIVS). The patient required permanent NIVS with continuous positive airway pressure, non-invasive ventilation, high flow nasal oxygen and body positioning. He was weaned from NIVS after 37 days and started exercise training afterwards. The patient was discharged at home with low-flow oxygen therapy. This case represents an example of a successful treatment of AHRF with the still controversial noninvasive respiratory support in one patient with COVID-19.

scholarly journals Use of awake proning to avoid invasive ventilation in a patient with severe COVID-19 pneumonitis

2020 ◽  
Vol 13 (8) ◽  
pp. e236586 ◽  
Author(s):  
Paul Whittemore ◽  
Laura Macfarlane ◽  
Anna Herbert ◽  
John Farrant
Keyword(s):  
Hospital Stay ◽  
Ct Imaging ◽  
Low Flow ◽  
Ground Glass ◽  
High Dependency Unit ◽  
Day Hospital ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
High Dependency

A 60-year-old man with swab-positive COVID-19 and extensive ground-glass change seen on CT imaging was successfully managed on our COVID-19 high-dependency unit with only low-flow oxygen and strict awake proning instructions. He was successfully weaned off oxygen entirely without any requirement for non-invasive or invasive ventilation and made a recovery to be discharged home after an 18-day hospital stay.

scholarly journals Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience

2020 ◽  
Vol 7 (1) ◽  
pp. e000678 ◽  
Author(s):  
Rob J Hallifax ◽  
Benedict ML Porter ◽  
Patrick JD Elder ◽  
Sarah B Evans ◽  
Chris D Turnbull ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Outcomes ◽  
High Flow ◽  
Respiratory Support ◽  
Severe Illness ◽  
High Dependency Unit ◽  
Single Centre ◽  
High Dependency ◽  
Improved Outcomes ◽  
Continuous Positive Airways Pressure

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.

High-dependency care

2010 ◽  
Keyword(s):  
Tracheal Tube ◽  
Respiratory Support ◽  
Haemodynamic Monitoring ◽  
Non Invasive ◽  
Dependency Care ◽  
High Dependency ◽  
High Dependency Care ◽  
Nasopharyngeal Airway

Assessing airway safety 788Assisting with tracheal tube intubation 790Insertion of a nasopharyngeal airway 792Assessing respiratory effectiveness 794Assessing perfusion 796Haemodynamic monitoring 798Methods of non-invasive respiratory support 800Invasive methods of respiratory support 802Care of the ventilated child 804Complications of intubation and ventilation ...

scholarly journals Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant

2021 ◽  
Vol 8 (1) ◽  
pp. e001044
Author(s):  
Chris D Turnbull ◽  
Benedict M L Porter ◽  
Sarah B Evans ◽  
Oliver Smith ◽  
Rachel Lardner ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Single Centre ◽  
Non Invasive ◽  
High Dependency ◽  
Single Centre Experience ◽  
Alpha Variant ◽  
The Impact ◽  
Second Wave

IntroductionRespiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes.MethodsWe conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves.ResultsIn total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, χ2=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, χ2=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave.DiscussionOur single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial.

Sign in / Sign up

Export Citation Format

Share Document