Continuous positive airway pressure for respiratory support during COVID-19 pandemic: a frugal approach from bench to bedside
Guillaume Carteaux,Guillaume Carteaux,Manuella Pons,Francois Morin,Samuel Tuffet,Samuel Tuffet,Arnaud Lesimple,Bilal Badat,Anne-Fleur Haudebourg,Anne-Fleur Haudebourg,François Perier,François Perier,Yvon Deplante,Constance Guillaud,Frédéric Schlemmer,Elena Fois,Nicolas Mongardon,Mehdi Khellaf,Karim Jaffal,C. Deguillard,Philippe Grimbert,Raphaëlle Huguet,Keyvan Razazi,Keyvan Razazi,Nicolas de Prost,Nicolas de Prost,François Templier,François Beloncle,Alain Mercat,Laurent Brochard,Laurent Brochard,Vincent Audard,Pascal Lim,Jean-Christophe Richard,Jean-Christophe Richard,Dominique Savary,Armand Mekontso Dessap,Armand Mekontso Dessap +37 more
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In this paper, the authors describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19 patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter in and out the ICU.Abstract:
We describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19 patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter (“Filter Frugal CPAP”, FF-CPAP) in and out the ICU. (1) A bench study measured the impact of two filters with different mechanical properties on CPAP performances, and pressures were also measured in patients. (2) Non-ICU healthcare staff working in COVID-19 intermediate care units were trained with a video tutorial posted on a massive open online course. (3) A clinical study assessed the feasibility and safety of using FF-CPAP to maintain oxygenation and manage patients out of the ICU during a massive outbreak. Bench assessments showed that adding a filter did not affect the effective pressure delivered to the patient. The resistive load induced by the filter variably increased the simulated patient’s work of breathing (6–34%) needed to sustain the tidal volume, depending on the filter’s resistance, respiratory mechanics and basal inspiratory effort. In patients, FF-CPAP achieved pressures similar to those obtained on the bench. The massive training tool provided precious information on the use of Boussignac FF-CPAP on COVID-19 patients. Then 85 COVID-19 patients with ICU admission criteria over a 1-month period were studied upon FF-CPAP initiation for AHRF. FF-CPAP significantly decreased respiratory rate and increased SpO2. Thirty-six (43%) patients presented with respiratory indications for intubation prior to FF-CPAP initiation, and 13 (36%) of them improved without intubation. Overall, 31 patients (36%) improved with FF-CPAP alone and 17 patients (20%) did not require ICU admission. Patients with a respiratory rate > 32 breaths/min upon FF-CPAP initiation had a higher cumulative probability of intubation (p < 0.001 by log-rank test). Adding a filter to the Boussignac valve does not affect the delivered pressure but may variably increase the resistive load depending on the filter used. Clinical assessment suggests that FF-CPAP is a frugal solution to provide a ventilatory support and improve oxygenation to numerous patients suffering from AHRF in the context of a massive outbreak.read more
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