scholarly journals Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

2020 ◽  
Vol 9 (4) ◽  
pp. 1191 ◽  
Author(s):  
Dejan Radovanovic ◽  
Maurizio Rizzi ◽  
Stefano Pini ◽  
Marina Saad ◽  
Davide Alberto Chiumello ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Air Dispersion ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen ◽  
Hypoxic Respiratory Failure ◽  
Term Tolerability ◽  
Care Assistance

Since the beginning of March 2020, the coronavirus disease 2019 (COVID-19) pandemic has caused more than 13,000 deaths in Europe, almost 54% of which has occurred in Italy. The Italian healthcare system is experiencing a stressful burden, especially in terms of intensive care assistance. In fact, the main clinical manifestation of COVID-19 patients is represented by an acute hypoxic respiratory failure secondary to bilateral pulmonary infiltrates, that in many cases, results in an acute respiratory distress syndrome and requires an invasive ventilator support. A precocious respiratory support with non-invasive ventilation or high flow oxygen should be avoided to limit the droplets’ air-dispersion and the healthcare workers’ contamination. The application of a continuous positive airway pressure (CPAP) by means of a helmet can represent an effective alternative to recruit diseased alveolar units and improve hypoxemia. It can also limit the room contamination, improve comfort for the patients, and allow for better clinical assistance with long-term tolerability. However, the initiation of a CPAP is not free from pitfalls. It requires a careful titration and monitoring to avoid a delayed intubation. Here, we discuss the rationale and some important considerations about timing, criteria, and monitoring requirements for patients with COVID-19 respiratory failure requiring a CPAP treatment.

scholarly journals Feasibility of non-invasive nitric oxide inhalation in acute hypoxic respiratory failure: potential role during the COVID-19 pandemic

2020 ◽  
Author(s):  
Kiran Shekar ◽  
Sneha Varkey ◽  
George Cornmell ◽  
Leanne Parsons ◽  
Maneesha Tol ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Respiratory Failure ◽  
Arterial Oxygen ◽  
Respiratory Muscle Fatigue ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Nasal Cannulae ◽  
Nitric Oxide Inhalation ◽  
Hypoxic Respiratory Failure

Acute hypoxemic respiratory failure (ARF) is characterized by both lower arterial oxygen and carbon dioxide tensions in the blood. First line treatment for ARF includes oxygen therapy,intially admininstered non invasively using nasal prongs, high flow nasal cannulae or masks. Invasive mechancial ventilation (IMV) is usually reserved for patients who are unable to maintain their airway, those with worsening hypoxemia, or those who develop respiratory muscle fatigue and consequent hypercapnia. Inhaled nitric oxide (iNO) gas is known to improve oxygenation in patients with ARF by manipulating ventilation-perfusion matching. Addition of iNO may potentially alleviate the need for IMV in selected patients. This article demonstrates the feasibility of this technique based on our experience of patients with hypoxemic ARF. This technique may also be considered for patients with hypoxic ARF in setting of COVID-19.

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.

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