High success and low mortality rates with non-invasive ventilation in influenza A H1N1 patients in a tertiary hospital

Abstract Introduction In motor neuron disease (MND), non-invasive ventilation (NIV) in patients who develop respiratory muscle weakness improves both quality of life and survival. This study aimed to evaluate the current practice and outcomes of NIV use in MND patients in an Australian tertiary hospital. Methods The medical records of all MND patients who attended a specialist multidisciplinary clinic requiring NIV treatment between January 2015 and January 2020 were retrospectively analysed. Progress to date: Forty-five patients have been analysed with a mean age at time of NIV commencement of 61±10(SD) years, 67% were male, 33% were current or past smokers and 7% had OSA with previous CPAP use. MND onset was limb in 58%, bulbar in 36% and respiratory muscle in 7%. Riluzole was prescribed in 47% and PEG/RIG insertion performed in 47%. At time of NIV commencement, 82% were symptomatic and 47% hypercapnic. No patient was commenced based on functional testing alone. NIV adherence (usage ≥4hours/night) was observed in 80%. NIV non-adherence was associated with bulbar subtype (p=0.02) and empirical NIV initiation (p<0.01) on univariate analysis. Average survival from NIV commencement was 17±22(SD)months. Average survival on NIV in adherent patients was 19±24(SD)months and non-adherent patients was 2±2(SD)months, although this did not reach statistical significance (p=0.1). Intended outcome & impact Overall clinical practice and outcomes of NIV use in this study is comparable to literature. The factors influencing NIV tolerance and adherence require further study to optimise outcomes in MND patients with respiratory muscle weakness.

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High-flow nasal oxygen therapy alone or with non-invasive ventilation in immunocompromised patients admitted to ICU for acute hypoxemic respiratory failure: the randomised multicentre controlled FLORALI-IM protocol

BMJ Open ◽

10.1136/bmjopen-2019-029798 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029798 ◽

Cited By ~ 3

Author(s):

Rémi Coudroy ◽

Jean-Pierre Frat ◽

Stephan Ehrmann ◽

Frédéric Pène ◽

Nicolas Terzi ◽

...

Keyword(s):

Respiratory Failure ◽

Oxygen Therapy ◽

Mortality Rates ◽

High Flow ◽

Immunocompromised Patients ◽

Invasive Ventilation ◽

Hypoxemic Respiratory Failure ◽

Acute Hypoxemic Respiratory Failure ◽

Non Invasive ◽

Non Invasive Ventilation

IntroductionNon-invasive ventilation (NIV) is recommended as first-line therapy in respiratory failure of critically ill immunocompromised patients as it can decrease intubation and mortality rates as compared with standard oxygen. However, its recommendation is only conditional. Indeed, the use of NIV in this setting has been challenged recently based on results of trials finding similar outcomes with or without NIV or even deleterious effects of NIV. To date, NIV has been compared with standard oxygen but not to high-flow nasal oxygen therapy (HFOT) in immunocompromised patients. Several studies have found lower mortality rates using HFOT alone than when using HFOT with NIV sessions in patients with de novo respiratory failure, and even in immunocompromised patients. We are hypothesising that HFOT alone is more effective than HFOT with NIV sessions and reduces mortality of immunocompromised patients with acute hypoxemic respiratory failure.Methods and analysisThis study is an investigator-initiated, multicentre randomised controlled trial comparing HFOT alone or with NIV in immunocompromised patients admitted to intensive care unit (ICU) for severe acute hypoxemic respiratory failure. Around 280 patients will be randomised with a 1:1 ratio in two groups. The primary outcome is the mortality rate at day 28 after inclusion. Secondary outcomes include the rate of intubation in each group, length of ICU and hospital stay and mortality up to day 180.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT02978300

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The Impact of Non-Invasive Ventilation to Readmission and Sort-Term Mortality Rates in Hospitalized Patients with Pneumonia Coming from Community

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2133 ◽

2020 ◽

Author(s):

A.S. Sadigov ◽

I. Mammadova ◽

A. Agayeva

Keyword(s):

Mortality Rates ◽

Hospitalized Patients ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

The Impact

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Survival analysis of all critically ill patients with COVID-19 admitted to the main hospital in Mogadishu, Somalia, 30 March to 12 June 2020: what interventions are proving effective?

10.1101/2021.01.01.20248966 ◽

2021 ◽

Author(s):

Mohamed M Ali ◽

Mamunur Rahman Malik ◽

Abdulrazaq Yusuf Ahmed ◽

Ahmed Mohamed Bashir ◽

Abdulmunim Mohamed ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Public Sector ◽

Survival Probability ◽

Tertiary Hospital ◽

Hospital Death ◽

Invasive Ventilation ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Increased Risk

OBJECTIVES To determine risk factors for death in patients with COVID-19 admitted to the main public sector hospital in Somalia and identify interventions contributing to improved clinical outcome in a low resource and fragile setting. SETTING Main public sector tertiary hospital in Mogadishu, Somalia. PARTICIPANTS All 131 laboratory confirmed COVID19 patients admitted to the main public tertiary hospital in Somalia between 30 March and 12 June 2020. MAIN OUTCOME MEASURES We extracted demographic and clinical data from hospital records of all 131 COVID19 patients admitted to hospital until their death or recovery. We used Kaplan Meier statistics to estimate survival probabilities and the logrank test to assess significant differences in survival between groups. We used the Cox proportional hazard model to estimate likelihood of death and assess the effect of risk factors on survival. RESULTS Of the 131 patients, 52 (40%) died in the hospital and 79 (60%) survived to discharge. The factors independently associated with increased risk of in-hospital death were: age ≥ 60 years survival probability on day 21 in patients < 60 years was 0.789 (95% confidence interval (CI): 0.658,0.874) compared with 0.339 (95% CI: 0.205,0.478) in patients ≥ 60 years; cardiovascular disease (survival probability 0.478 (95% CI: 0.332,0.610) in patients with cardiovascular disease compared with 0.719 (95% CI: 0.601, 0.807) in patients without cardiovascular disease); and non-invasive ventilation on admission patients who were not ventilated were significantly more likely to survive than those who were (P < 0.001). CONCLUSION Our study, which includes the largest cohort of COVID19 patients admitted to a single hospital in a sub-Saharan African country, confirms that underlying conditions and age are associated with increased risk of in hospital death in patients with COVID-19. Our results show the advantage of medical oxygen over non-invasive ventilation in the treatment of patients with severe COVID-19 symptoms.

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