scholarly journals High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nicolas Bonnet ◽  
Olivier Martin ◽  
Marouane Boubaya ◽  
Vincent Levy ◽  
Nathan Ebstein ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Propensity Score ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Icu Admission ◽  
Icu Stay ◽  
Tertiary Hospitals ◽  
Length Of Icu Stay

Abstract Background The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients. Methods This was a bicenter retrospective study which took place in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. We enrolled consecutive patients hospitalized for COVID-19 and acute respiratory failure (ARF) who did not receive IMV at ICU admission. The primary outcome was the rate of IMV after ICU admission. Secondary outcomes were death at day 28 and day 60, length of ICU stay and ventilator-free days at day 28. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group using weighted propensity score. Results Among 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. In HFNO group, 39/76 (51%) patients received IMV and 46/62 (74%) in SOT group (OR 0.37 [95% CI, 0.18–0.76] p = 0.007). After weighted propensity score, HFNO was still associated with a lower rate of IMV (OR 0.31 [95% CI, 0.14–0.66] p = 0.002). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after weighted propensity score. Ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p = 0.005). In the HFNO group, predictive factors associated with IMV were SAPS2 score (OR 1.13 [95%CI, 1.06–1.20] p = 0.0002) and ROX index > 4.88 (OR 0.23 [95%CI, 0.008–0.64] p = 0.006). Conclusions High flow nasal canula oxygen for ARF due to COVID-19 is associated with a lower rate of invasive mechanical ventilation.

scholarly journals Correlation of Oxygen Consumption and Patient Day with Invasive Mechanical Ventilation in a Hospital in Sao Paulo during Covid-19 Pandemic

2021 ◽  
Vol 6 (11) ◽  
pp. 835-839
Author(s):  
Kaio Jia Bin ◽  
Luana Alcantara Machado ◽  
Nivaldo Fracacio Junior ◽  
Francis Mironescu Tomazini ◽  
Paula Cristina Souto De Camargo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Consumption ◽  
Retrospective Study ◽  
Strong Correlation ◽  
Oxygen Therapy ◽  
Invasive Mechanical Ventilation ◽  
Single Center ◽  
Billing Data ◽  
Central Institute ◽  
The World

Background: The new coronavirus led the world into the pandemic known as COVID-19. Still, without any effective treatment, oxygen therapy is the most used treatment for patients. Without proper management of this medicinal gas, lives can be lost for lack of it. Aim: Find an indicator of a strong correlation with oxygen consumption. Methods: A single-center retrospective study, that evaluated the oxygen consumption billing data and patient-day indicator of Central Institute of HCFMUSP between 2019 and 2020. Results: A total of 380,245 patient days were analyzed. A strong correlation was identified between oxygen consumption and patient day with invasive mechanical ventilation (0.92). An average of 41.6 (± 7.8) cubic meters per patient day with invasive mechanical ventilation was found. Conclusion: There is a strong correlation between oxygen consumption in cubic meters and patient days with invasive mechanical ventilation at the Central Institute of HCFMUSP. The average values of consumption per patient day can help in planning oxygen management in other hospitals.

scholarly journals Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry

2021 ◽  
Vol 10 (10) ◽  
pp. 2214
Author(s):  
Manuel Rubio-Rivas ◽  
Xavier Corbella ◽  
Francesc Formiga ◽  
Estela Menéndez Fernández ◽  
María Martín Escalante ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
High Risk ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Icu Admission ◽  
Inflammatory Parameters ◽  
Risk Categories

(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters.

scholarly journals Effect of ROX Index on the Ventilator Free Days in High Flow Nasal Oxygen and Early Invasive Mechanical Ventilation in Adult COVID -19 Patients

2021 ◽  
Vol 11 (11) ◽  
pp. 203-207
Author(s):  
Joslita Rebello ◽  
Monisha B. J. Neelankavil ◽  
Ananth Srikrishna Somayaji
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Clinical Outcome ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Apache Ii ◽  
Secondary Outcome ◽  
Duration Of Stay ◽  
Icu Stay ◽  
Significant Difference

Background: High flow nasal oxygen (HFNO) is used as an alternative respiratory support in hypoxemic respiratory failure in COVID -19. However the use of HFNO was associated with a lower risk of invasive mechanical ventilation and duration of stay in ICU. This study is aimed at comparing ventilator free days and duration of ICU stay between early mechanical ventilation and HFNO use in COVID -19 to predict the clinical outcome. Methods: We performed a unicentre prospective observational analytical study on subjects with respiratory failure due to COVID -19 comparing effect of ROX index on ventilator free days with use of HFNO therapy and mechanical ventilation on first day of intensive care unit admission. Each group had 20 subjects. Clinical outcome was measured in terms of ventilator free days between two groups. Standard statistical comparisons were used to compare the length of icu stay as secondary outcome. APACHE II and SOFA sores were compared and analysed between two groups. Results: 40 adult subjects critically ill due to COVID -19 were included in the study with 20 in each group. Subjects in HFNO group had higher ventilator free days than those were put on early mechanical ventilation with significant difference. Whereas the duration of icu stay was prolonged in HFNO group but there was no significant statistical difference. Conclusions: In this prospective study HFNO had better clinical outcome in terms of ventilator free days compared to early mechanical ventilation. Duration of stay in ICU had no difference. Key words: Ventilator free days, HFNO, number of days in ICU, ROX index, APACHE II, SOFA score.

The Total Inotrope Exposure Score: an extension of the Vasoactive Inotrope Score as a predictor of adverse outcomes after paediatric cardiac surgery

2017 ◽  
Vol 27 (6) ◽  
pp. 1146-1152 ◽  
Author(s):  
Harish Bangalore ◽  
Michael Gaies ◽  
Elena C. Ocampo ◽  
Jeffrey S. Heinle ◽  
Danielle Guffey ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Drug Exposure ◽  
Invasive Mechanical Ventilation ◽  
Study Cohort ◽  
Icu Stay ◽  
Average Maximum ◽  
Inotrope Score ◽  
Length Of Icu Stay

AbstractObjectiveThe aim of the present study was to explore and compare the association between a new vasoactive score – the Total Inotrope Exposure Score – and outcome and the established Vasoactive Inotrope Score in children undergoing cardiac surgery with cardiopulmonary bypassDesignThe present study was a single-centre, retrospective study.SettingThe study was carried out at a 21-bed cardiovascular ICU in a Tertiary Children’s Hospital between September, 2010 and May, 2011MethodsThe Total Inotrope Exposure Score is a new vasoactive score that brings together cumulative vasoactive drug exposure and incorporates dose adjustments over time. The performance of these scores – average, maximum Vasoactive Inotrope Score at 24 and 48 hours, and Total Inotrope Exposure Score – to predict primary clinical outcomes – either death, cardiopulmonary resuscitation, or extra-corporeal membrane oxygenation before hospital discharge – and secondary outcomes – length of invasive mechanical ventilation, length of ICU stay, and hospital stay – was calculated.Main resultsThe study cohort included 167 children under 18 years of age, with 37 (22.2%) neonates and 65 (41.3%) infants aged between 1 month and 1 year. The Total Inotrope Exposure Score best predicted the primary outcome (six of 167 cases) with an unadjusted odds ratio for a poor outcome of 42 (4.8, 369.6). Although the area under curve was higher than other scores, this difference did not reach statistical significance. The Total Inotrope Exposure Score best predicted prolonged invasive mechanical ventilation, length of ICU stay, and hospital stay as compared with the other scores.ConclusionThe Total Inotrope Exposure Score appears to have a good association with poor postoperative outcomes and warrants prospective validation across larger numbers of patients across institutions.

scholarly journals Predictors of failure with high-flow nasal oxygen therapy in COVID-19 patients with acute respiratory failure: a multicentre observational study

2020 ◽  
Author(s):  
Ricard Mellado Artigas ◽  
Luis Eduardo Mujica ◽  
Magda Liliana Ruiz ◽  
Bruno Leonel Ferreyro ◽  
Federico Angriman ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Observational Study ◽  
Acute Respiratory Failure ◽  
Predictive Model ◽  
Endotracheal Intubation ◽  
Sofa Score ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Icu Admission

Abstract Purpose We aimed to describe the use of high-flow nasal oxygen (HFNO) in patients with COVID-19 acute respiratory failure and factors associated with a shift to invasive mechanical ventilation. Methods This is a multicentre, observational study from a prospectively collected database of consecutive COVID-19 patients admitted to 36 Spanish and Andorran intensive care units (ICUs) who received HFNO on ICU admission during a 22-week period (March 12-August 13, 2020). Outcomes of interest were factors on the day of ICU admission associated with the need for endotracheal intubation. We used multivariable logistic regression and mixed effects models. A predictive model for endotracheal intubation in patients treated with HFNO was derived and internally validated. Results From a total of 259 patients initially treated with HFNO, 140 patients (54%) required invasive mechanical ventilation. Baseline non-respiratory Sequential Organ Failure Assessment (SOFA) score [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.41–2.35], and the ROX index calculated as the ratio of partial pressure of arterial oxygen to inspired oxygen fraction divided by respiratory rate (OR 0.53; 95% CI: 0.37–0.72), and pH (OR 0.47; 95% CI: 0.24–0.86) were associated with intubation. Hospital site explained 1% of the variability in the likelihood of intubation after initial treatment with HFNO. A predictive model including non-respiratory SOFA score and the ROX index showed excellent performance (AUC 0.88, 95%CI 0.80–0.96). Conclusions Among adult critically ill patients with COVID-19 initially treated with HFNO, the SOFA score and the ROX index may help to identify patients with higher likelihood of intubation.

scholarly journals Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2259
Author(s):  
Barbara Bonnesen ◽  
Jens-Ulrik Stæhr Jensen ◽  
Klaus Nielsen Jeschke ◽  
Alexander G. Mathioudakis ◽  
Alexandru Corlateanu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Continuous Positive Airway Pressure ◽  
Acute Respiratory Failure ◽  
Airway Pressure ◽  
Oxygen Therapy ◽  
Positive Airway Pressure ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Current Evidence

Patients admitted to hospital with coronavirus disease 2019 (COVID-19) may develop acute respiratory failure (ARF) with compromised gas exchange. These patients require oxygen and possibly ventilatory support, which can be delivered via different devices. Initially, oxygen therapy will often be administered through a conventional binasal oxygen catheter or air-entrainment mask. However, when higher rates of oxygen flow are needed, patients are often stepped up to high-flow nasal cannula oxygen therapy (HFNC), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or invasive mechanical ventilation (IMV). BiPAP, CPAP, and HFNC may be beneficial alternatives to IMV for COVID-19-associated ARF. Current evidence suggests that when nasal catheter oxygen therapy is insufficient for adequate oxygenation of patients with COVID-19-associated ARF, CPAP should be provided for prolonged periods. Subsequent escalation to IMV may be implemented if necessary.

scholarly journals Failure of High-Flow Nasal Cannula and Non-invasive Ventilation Can Be Associated with Increased Risk of Mortality and Morbidity in Critically Ill Children

2019 ◽  
Author(s):  
Fatih AYGUN ◽  
CANSU DURAK ◽  
Fatih VAROL ◽  
Alper KACAR ◽  
Emre AYGUN ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Critically Ill ◽  
Invasive Mechanical Ventilation ◽  
High Flow ◽  
Critically Ill Children ◽  
High Flow Nasal Cannula ◽  
Mortality And Morbidity ◽  
Non Invasive ◽  
Risk Of Mortality

Abstract Background: This retrospective study aimed to describe the efficacy, complications, and outcome of non-invasive mechanical ventilation (NIV) in critically ill children. Non-invasive mechanical ventilation (NIV) has achieved a significant breakthrough success in treating acute respiratory failure. NIV failure drastically increases the risk of mortality and morbidity. Many factors have been associated with the success of NIV. Methods. We performed a multicenter retrospective study using the demographic, prognostic, and laboratory findings of children (<18 years old) who were admitted in two pediatric intensive care units (PICUs). We compared clinical and laboratory variables in both successful and failed NIV groups. Results. Between January 2014 and April 2019, 1101 children were admitted to two PICU wards, of which, 403 were eligible for this study. In total, 138 (34.2%) patients received high-flow nasal cannula (HFNC), 138 (34.2%) patients received NIV-pressure control and 127 (31.6%) received NIV-pressure support (PSV). Patient mortality was 3.2% (13 patients) and the success rate of our study was 83.4%. Majority of our patients were provided NIV on admission (62.8%). Patients with successful NIV required fewer inotropic drugs, had shorter PICU stay duration, and a lower mortality rate during the follow up. The failure group presented a greater frequency of NIV-PSV and NIV-PCV use, along with higher NIV-associated complications. Logistic regression analysis revealed that NIV and HFNC failure increased PICU mortality by 19 times. Conclusions. HFNC and NIV are support modalities for respiratory distress in the PICU and were associated with a significant decrease in the PICU intubation rate.

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