scholarly journals Post-COVID19 Lung Fibrosis: An Worrying Experience of COVID19 Survivors

2021 ◽  
Vol 33 (1) ◽  
pp. 114-119
Author(s):  
SM AA Mamun ◽  
Zafor Iqbal ◽  
Arif Mahmood ◽  
Sania Ahsan
Keyword(s):  
Lung Fibrosis ◽  
Observational Studies ◽  
Severe Disease ◽  
High Flow ◽  
High Flow Nasal Cannula ◽  
Exertional Dyspnea ◽  
Severe Reduction ◽  
Set Up ◽  
Fibrotic Lung Disease

Patients recovering from confirmed COVID19 particularly moderate to severe disease, those treated in HDU / ICU support with high flow nasal cannula & Mechanical ventilation ,experienced different symptoms ranging from tiredness, fatigue to severe exertional dyspnea. High resolution CT scan of Chest of these such patients showed persistent radiological abnormalities simulating progressive fibrotic lung disease. Lung function including CO transfer factor revealed moderate to severe reduction. In case of patients recovered from moderate to severe COVID19 pneumonia, lung fibrosis is a big problem and it is one of the most worrying long-term complications. Lung fibrosis was documented in previous Severe Acute Respiratory Syndrome & Middle east Respiratory Syndrome pathology, and current observational studies suggests that pulmonary fibrosis could also complicate infection by SARSCOV2. The objective of our study was to set up a criteria of patients who are at risk to develop such serious complication, thus giving a chance for early detection of post-COVID19 lung fibrosis and thus preventing such disabling complication by proper andearly intervention . Bangladesh J Medicine July 2022; 33(1) : 114-119

scholarly journals Development in PaCO2 over 12 months in patients with COPD with persistent hypercapnic respiratory failure treated with high-flow nasal cannula—post-hoc analysis from a randomised controlled trial

2020 ◽  
Vol 7 (1) ◽  
pp. e000712
Author(s):  
Line Hust Storgaard ◽  
Hans-Ulrich Hockey ◽  
Ulla Møller Weinreich
Keyword(s):  
Hospital Admissions ◽  
Blood Gases ◽  
High Flow ◽  
Nasal Cannula ◽  
Control Group ◽  
High Flow Nasal Cannula ◽  
Exacerbation Rate ◽  
Post Hoc Analysis ◽  
Post Hoc

IntroductionPersistent hypercapnic failure in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis. Long-term home non-invasive ventilation is recommended for patients with PaCO2 >7.0 kPa. Domiciliary high-flow nasal cannula (HFNC) reduces PaCO2 in short-term studies. This post-hoc analysis examines the effect of HFNC on PaCO2 levels, exacerbations and admissions in patients with COPD with persistent hypercapnic and hypoxic failures.MethodsThe original trial included 74 long-term oxygen-treated patients (31 HFNC treated/43 controls) with persistent hypercapnic failure (PaCO2 >6 kPa) who completed the 12-month study period. Baseline data included age, sex, blood gases, exacerbations and hospital admissions in the previous year. Data on blood gases were also recorded at 6 and 12 months for all patients. In addition, acute changes in blood gases after 30 min of HFNC use at site visits were examined, as were exacerbations and hospital admissions during study.ResultsPatients were comparable at baseline. After 12 months there was a 1.3% decrease in PaCO2 in patients using HFNC and a 7% increase in controls before HFNC use on site (p=0.003). After 30 min of HFNC at visits PaCO2 changed significantly, with comparable reductions, at 0, 6 and 12 months, including for controls who tried HFNC at study end (p<0.001). The exacerbation rate increased, compared with 12 months prestudy, by 2.2/year for controls (p<0.001) and 0.15/year for HFNC-treated patients (p=0.661). Hospital admission rates increased in the control group,+0.3/year from prestudy (p=0.180), And decreased by 0.67/year (p=0.013)for HFNC-treated patients.ConclusionThis post-hoc analysis indicates that HFNC stabilises patients with COPD with persistent hypoxic and hypercapnic failures, in terms of PaCO2, exacerbations and number of hospitalisations, whereas those not receiving HFNC worsened. This suggests that HFNC is a possible treatment for patients with persistent hypercapnic COPD.

Is high-flow nasal cannula oxygenation more effective than noninvasive ventilation or conventional oxygen therapy in treating acute hypoxemic respiratory failure in COVID-19 patients?

2020 ◽  
Vol 54 ◽  
Author(s):  
Cary Amiel G. Villanueva ◽  
Marie Gene D. Cruz ◽  
Lia M. Palileo-Villanueva
Keyword(s):  
Respiratory Failure ◽  
Noninvasive Ventilation ◽  
Observational Studies ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
High Flow Nasal Cannula ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure

KEY FINDINGSVery low-quality evidence suggests lower mortality (based on five observational studies) but higher failurerate of respiratory support (based on two observational studies) in COVID-19 patients given high-flow nasalcannula (HFNC) oxygen compared with noninvasive ventilation (NIV) and conventional oxygenation therapy.Randomized controlled trials (RCT) are urgently needed in this area.• Respiratory failure accounts for about half of deaths in patients with COVID-19.• High-flow nasal cannula (HFNC) oxygen therapy reduces the need for escalating respiratory support and improvespatient comfort compared with conventional oxygen therapy among those with acute respiratory failure.• Mortality was consistently lower in COVID-19 patients who received HFNC rather than NIV or conventionaloxygen therapy (COT) across 5 very low-quality retrospective observational studies from China.• Several international guidelines recommend the use of HFNC oxygen therapy in COVID-19 patients whodevelop acute hypoxemic respiratory failure. However, local guidelines from the Philippine Society forMicrobiology and Infectious Diseases (PSMID) and the Philippine College of Chest Physicians (PCCP) recommendagainst HFNC due to risks of transmission and paucity of direct evidence for efficacy.• Additional infection control precautions, i.e. wearing a surgical mask over the cannula, and locating in a negativepressure room, are recommended whenever using HFNC or NIV.• There are at least two ongoing trials due to be completed by the second quarter of 2021 comparingHFNC oxygenation with NIV or COT in COVID-19 patients.

Helmet non-invasive ventilation compared to facemask non-invasive ventilation and high flow nasal cannula in acute respiratory failure: a systematic review and meta-analysis

2021 ◽  
pp. 2101269
Author(s):  
Dipayan Chaudhuri ◽  
Rehman Jinah ◽  
Karen E.A. Burns ◽  
Federico Angriman ◽  
Bruno Ferreyro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Observational Studies ◽  
Meta Analysis ◽  
High Flow ◽  
Invasive Ventilation ◽  
High Flow Nasal Cannula ◽  
Non Invasive ◽  
Icu Length Of Stay ◽  
Non Invasive Ventilation

BackgroundAlthough small randomised controlled trials (RCTs) and observational studies have examined helmet non-invasive ventilation (NIV), uncertainty remains regarding its role. We conducted a systematic review and meta-analysis to examine the effect of helmet NIV compared to facemask NIV or high flow nasal cannula (HFNC) in acute respiratory failure.MethodsWe searched multiple databases to identify RCTs and observational studies reporting on at least one of mortality, intubation, ICU length of stay, NIV duration, complications, or comfort with NIV therapy. We assessed study risk of bias (ROB) using the Cochrane ROB tool for RCTs and the Ottawa-Newcastle scale for observational studies and rated certainty of pooled evidence using GRADE.ResultsWe separately pooled data from 16 RCTs (n=949) and 8 observational studies (n=396). Compared to facemask NIV, based on low certainty evidence, helmet NIV may reduce mortality (relative risk (RR) 0.56, 95% confidence interval (CI) (0.33 to 0.95)), and intubation (RR 0.35, 95% CI (0.22 to 0.56)) in both hypoxic and hypercapnic respiratory failure but may have no effect on duration of NIV. There was an uncertain effect of helmet on ICU length of stay and development of pressure sores. Data from observational studies was consistent with the foregoing findings but of lower certainty. Based on low and very low certainty data, helmet NIV may reduce intubation compared to HFNC, but its effect on mortality is uncertain.ConclusionCompared to facemask NIV, helmet NIV may reduce mortality and intubation; however, the effect of helmet compared to HFNC remains uncertain.

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