High Failure Rate of Noninvasive Oxygenation Strategies in Critically Ill Subjects With Acute Hypoxemic Respiratory Failure Due to COVID-19.
Luca S Menga,Luca Delle Cese,Filippo Bongiovanni,Gianmarco Lombardi,Teresa Michi,Filippo Luciani,Marta Cicetti,Jacopo Timpano,Maria Cristina Ferrante,Melania Cesarano,Gian Marco Anzellotti,Tommaso Rosà,Daniele Natalini,Eloisa Sofia Tanzarella,Salvatore Lucio Cutuli,Gabriele Pintaudi,Gennaro De Pascale,Antonio Maria Dell'Anna,Giuseppe Bello,Mariano Alberto Pennisi,Salvatore Maurizio Maggiore,Riccardo Maviglia,Domenico Luca Grieco,Massimo Antonelli +23 more
TLDR
In this paper, a prospective observational study was conducted to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19.Abstract:
BACKGROUND: The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19. METHODS: Patients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, P aO 2 /F IO 2 and P aCO 2 at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes. RESULTS: A total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and high-flow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score (P = .009) and serum lactate dehydrogenase at enrollment (P = .02); the combination of SAPS II score ≥ 33 with serum lactate dehydrogenase ≥ 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, P = .02), with an adjusted hazard ratio of 2 (95% CI 1.1–3.6, P = .01). CONCLUSIONS: As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score ≥ 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk.read more
Citations
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Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure: The HENIVOT Randomized Clinical Trial.
Domenico Luca Grieco,Luca S Menga,Melania Cesarano,Tommaso Rosà,Savino Spadaro,Maria Maddalena Bitondo,Jonathan Montomoli,Giulia Falò,Tommaso Tonetti,Salvatore Lucio Cutuli,Gabriele Pintaudi,Eloisa Sofia Tanzarella,Edoardo Piervincenzi,Filippo Bongiovanni,Antonio Maria Dell’Anna,Luca Delle Cese,Cecilia Berardi,Simone Carelli,Maria Grazia Bocci,Luca Montini,Giuseppe Bello,Daniele Natalini,Gennaro De Pascale,Gennaro De Pascale,Matteo Velardo,Carlo Alberto Volta,V. Marco Ranieri,Giorgio Conti,Salvatore Maurizio Maggiore,Massimo Antonelli +29 more
TL;DR: In this article, the helmet noninvasive ventilation was compared with high-flow nasal oxygen alone in patients with COVID-19 and moderate to severe hypoxemic respiratory failure.
Journal ArticleDOI
Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS.
Domenico Luca Grieco,Salvatore Maurizio Maggiore,Oriol Roca,Elena Spinelli,Bhakti K. Patel,Arnaud W. Thille,Carmen Silvia Valente Barbas,Carmen Silvia Valente Barbas,Marina Garcia de Acilu,Salvatore Lucio Cutuli,Filippo Bongiovanni,Marcelo B. P. Amato,Jean Pierre Frat,Tommaso Mauri,John P. Kress,Jordi Mancebo,Massimo Antonelli +16 more
TL;DR: The role of non-invasive respiratory support (high-flow nasal oxygen and noninvasive ventilation) in the management of acute hypoxemic respiratory failure and acute respiratory distress syndrome is debated as mentioned in this paper.
Journal ArticleDOI
Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review.
Denise Battaglini,Denise Battaglini,Chiara Robba,Lorenzo Ball,Pedro L. Silva,Pedro L. Silva,Fernanda F. Cruz,Fernanda F. Cruz,Paolo Pelosi,Patricia R. M. Rocco,Patricia R. M. Rocco +10 more
TL;DR: In this article, the authors provide an overview of P-SILI pathophysiology and the role of non-invasive respiratory support in COVID-19 pneumonia, and decide on the optimal timing of intubation for these patients.
Journal ArticleDOI
The use of head helmets to deliver noninvasive ventilatory support: a comprehensive review of technical aspects and clinical findings.
TL;DR: A helmet, comprising a transparent hood and a soft collar, surrounding the patient's head can be used to deliver non-invasive ventilatory support, both as continuous positive airway pressure and noninvasive positive pressure ventilation (NPPV), the latter providing active support for inspiration as discussed by the authors.
Journal ArticleDOI
Noninvasive respiratory support for COVID-19 patients: when, for whom, and how?
Zachary P. Sullivan,Luca Zazzeron,Lorenzo Berra,Dean R. Hess,Edward A. Bittner,Marvin G. Chang +5 more
TL;DR: In this paper , an algorithm for noninvasive respiratory support (NIRS) in COVID-19 patients with mild respiratory disease and prior pandemics is proposed. But, the authors do not consider the potential negative effects of NIRS on patients with more advanced respiratory disease.
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