The Use of Intermittent Non-Invasive Ventilation as an Alveolar Recruitment Method for Patient with Severe COVID 19 Pneumonia

2021 ◽  
Vol 03 ◽  
Author(s):  
Mazen Zouwayhed ◽  
Saria Gouher ◽  
Balu Bhaskar ◽  
Moeena Zain ◽  
Samer Burghleh ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Standard Care ◽  
Alveolar Recruitment ◽  
Hospital Length Of Stay ◽  
Invasive Ventilation ◽  
Recruitment Method ◽  
American Hospital ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Taking Care

Background: The use of non-invasive ventilation (NIV) as a therapy for acute respiratory distress syndrome (ARDS) secondary to COVID 19 pneumonia has been controversial. NIV is an aerosol generating procedure which may increase the risk of viral transmission amongst patients and staff. Because of fear of aerosolizing the virus and transmitting the disease, initial expert recommendation was to avoid NIV and proceed with early intubation. With further experience of the virus, this recommendation has been challenged and NIV has been used widely with some retrospective studies quoting between 11 to 56 percent of COVID 19 related respiratory failures being treated with NIV. Objective: The objective of this study is to assess the efficacy and safety of using non-invasive mechanical ventilation as an alveolar recruitment method for patients with severe COVID 19 pneumonia. This method was used by our respiratory team on selected patients during the early phase of the COVID 19 pandemic. Methods: We reviewed the charts of patients that were admitted to the American Hospital Dubai intensive care unit, or our medical step-down unit who had diffuse bilateral infiltrates requiring oxygen supplementation between March and October 2020. We identified patients who were on intermittent BiPAP in addition to standard care. We also monitored the rate of infection among staff taking care of these patients. Results: Average length of stay after starting BIPAP therapy was 6.8 days, while the average total length of stay was 13.6 days. Only one patient was transferred to the ICU after being on the BIPAP protocol and did not need intubation. All patients were discharged home either without oxygen or with their chronic baseline home oxygen requirement. Radiological improvement in aeration was seen in 100% of patients at follow-up x-ray post-intervention. There were no reported pulmonary complications from barotrauma, such as pneumothorax or pneumomediastinum. There were no reported cases of staff infection to the health care workers that were taking care of these patients Conclusion: Our first of its kind observational study showed clearly that using BIPAP therapy for one hour three times daily during nebulization therapy in addition to standard care resulted in a significant reduction in hospital length of stay and hastened the clinical and radiological improvement of patients with severe COVID 19 pneumonia.

scholarly journals Awake Prone Positioning, High-Flow Nasal Oxygen and Non-Invasive Ventilation as Non-Invasive Respiratory Strategies in COVID-19 Acute Respiratory Failure: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 11 (2) ◽  
pp. 391
Author(s):  
Benedikt Schmid ◽  
Mirko Griesel ◽  
Anna-Lena Fischer ◽  
Carolina S. Romero ◽  
Maria-Inti Metzendorf ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Standard Care ◽  
Composite Endpoint ◽  
High Flow ◽  
Intubation Rate ◽  
Prone Positioning ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Background: Acute respiratory failure is the most important organ dysfunction of COVID-19 patients. While non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) oxygen are frequently used, efficacy and safety remain uncertain. Benefits and harms of awake prone positioning (APP) in COVID-19 patients are unknown. Methods: We searched for randomized controlled trials (RCTs) comparing HFNC vs. NIV and APP vs. standard care. We meta-analyzed data for mortality, intubation rate, and safety. Results: Five RCTs (2182 patients) were identified. While it remains uncertain whether HFNC compared to NIV alters mortality (RR: 0.92, 95% CI 0.65–1.33), HFNC may increase rate of intubation or death (composite endpoint; RR 1.22, 1.03–1.45). We do not know if HFNC alters risk for harm. APP compared to standard care probably decreases intubation rate (RR 0.83, 0.71–0.96) but may have little or no effect on mortality (RR: 1.08, 0.51–2.31). Conclusions: Certainty of evidence is moderate to very low. There is no compelling evidence for either HFNC or NIV, but both carry substantial risk for harm. The use of APP probably has benefits although mortality appears unaffected.

scholarly journals Early extubation with immediate non-invasive ventilation versus standard weaning in intubated patients for coronavirus disease 2019: a retrospective multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Gianmaria Cammarota ◽  
Rosanna Vaschetto ◽  
Danila Azzolina ◽  
Nello De Vita ◽  
Carlo Olivieri ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Spontaneous Breathing Trial ◽  
Extubation Failure ◽  
Early Extubation ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Icu Length Of Stay ◽  
Non Invasive Ventilation ◽  
Hypoxemic Acute Respiratory Failure ◽  
Novel Coronavirus

AbstractIn patients intubated for hypoxemic acute respiratory failure (ARF) related to novel coronavirus disease (COVID-19), we retrospectively compared two weaning strategies, early extubation with immediate non-invasive ventilation (NIV) versus standard weaning encompassing spontaneous breathing trial (SBT), with respect to IMV duration (primary endpoint), extubation failures and reintubations, rate of tracheostomy, intensive care unit (ICU) length of stay and mortality (additional endpoints). All COVID-19 adult patients, intubated for hypoxemic ARF and subsequently extubated, were enrolled. Patients were included in two groups, early extubation followed by immediate NIV application, and conventionally weaning after passing SBT. 121 patients were enrolled and analyzed, 66 early extubated and 55 conventionally weaned after passing an SBT. IMV duration was 9 [6–11] days in early extubated patients versus 11 [6–15] days in standard weaning group (p = 0.034). Extubation failures [12 (18.2%) vs. 25 (45.5%), p = 0.002] and reintubations [12 (18.2%) vs. 22 (40.0%) p = 0.009] were fewer in early extubation compared to the standard weaning groups, respectively. Rate of tracheostomy, ICU mortality, and ICU length of stay were no different between groups. Compared to standard weaning, early extubation followed by immediate NIV shortened IMV duration and reduced the rate of extubation failure and reintubation.

The effect of Post-acute domiciliary non-invasive ventilation (NIV) on hospital admissions and length of stay (LOS)

2018 ◽  
Author(s):  
Alana Livesey ◽  
Amy Oakes ◽  
Pearlene Antoine-Pitterson ◽  
Emma Gallagher ◽  
Biman Chakraborty ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hospital Admissions ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Continuing Non-Invasive Ventilation During Amyotrophic Lateral Sclerosis-Related Hospice Care Is Medically, Administratively, and Financially Feasible

2020 ◽  
pp. 104990912098229
Author(s):  
Philip J. Choi ◽  
Michael Murn ◽  
Roberta Turner ◽  
Richard Bedlack
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Length Of Stay ◽  
Cost Analysis ◽  
Rating Scale ◽  
Academic Medical Center ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Als Patients ◽  
Lateral Sclerosis

Background: Amyotrophic Lateral Sclerosis (ALS) is a terminal neuromuscular disease with patients dying within 3-5 years of diagnosis. Most patients choose to forego invasive life sustaining measures. Timing of hospice referral can be challenging given the advancement of non-invasive ventilation (NIV) technology. Objective: To describe the characteristics of patients enrolled in hospice from an ALS clinic at 1 academic medical center and to perform a cost analysis for patients who remained on ventilator support. Methods: Retrospective cross-sectional study of patients enrolled in hospice over a 2-year period. Clinical characteristics included ALS Functional Rating Scale Revised (ALSFRS-R) score, Forced Vital Capacity (FVC), use of NIV and mechanical insufflation-exsufflation (MIE), riluzole use, and length of stay in hospice. A cost analysis was performed for patients enrolled in Duke Home Care and Hospice. Results: 85 of 104 patients who died were enrolled in hospice. Median days enrolled in hospice was 84. Patients who continued on NIV had similar hospice length of stay as those on no respiratory support (88 versus 80 days, p = 0.83). Bulbar patients had a trend toward shorter length of stay in hospice than limb onset patients (71 versus 101 days, p = 0.49). Cost analysis showed that hospice maintained a mean net operating revenue of $3234.50 per patient who continued on NIV. Conclusions: Hospice referrals for ALS patients on NIV can be challenging. This study shows that even with continued NIV use, most ALS patients die within the expected 6 months on home hospice, and care remains cost effective for hospice agencies.

scholarly journals High-flow oxygen therapy versus non-invasive ventilation: a randomised physiological cross-over study of alveolar recruitment in acute respiratory failure

2021 ◽  
pp. 00373-2021
Author(s):  
Elise Artaud-Macari ◽  
Michael Bubenheim ◽  
Gurvan Le Bouar ◽  
Dorothée Carpentier ◽  
Steven Grangé ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Alveolar Recruitment ◽  
Patient Comfort ◽  
Invasive Ventilation ◽  
Lung Volumes ◽  
Non Invasive ◽  
Non Invasive Ventilation

High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxemic acute respiratory failure (ARF) patients, while the interest of non-invasive ventilation (NIV) remains debated. The primary endpoint was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary endpoints compared regional EELI, lung volumes (global and regional tidal volume variation (TV)), respiratory parameters, hemodynamic tolerance, dyspnea and patient comfort between HFNC and NIV, relative to face mask (FM).A prospective randomised cross-over physiological study was conducted in patients with hypoxemic ARF due to pneumonia. They received alternately HFNC, NIV and FM.Sixteen patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95%CI: (857; 2646)) and 826 (95%CI: (399.5; 2361)) respectively. Global and regional TV increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher SpO2/ FiO2 ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1) but was lower with NIV (p=0.001).This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxemic ARF. In contrast with HFNC, NIV increased lung volumes which may contribute to overdistension and its potentially deleterious effect in these patients.

Sign in / Sign up

Export Citation Format

Share Document