A bstract Objective To determine whether high-flow nasal oxygen (HFNO) or noninvasive ventilator (NIV) can avoid invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (ADRS), and the outcome predictors of these modalities. Design Multicenter retrospective study conducted in 12 ICUs in Pune, India. Patients Patients with COVID-19 pneumonia who had PaO 2 /FiO 2 ratio <150 and were treated with HFNO and/or NIV. Intervention HFNO and/or NIV. Measurements The primary outcome was to assess the need of IMV. Secondary outcomes were death at Day 28 and mortality rates in different treatment groups. Main results Among 1,201 patients who met the inclusion criteria, 35.9% (431/1,201) were treated successfully with HFNO and/or NIV and did not require IMV. About 59.5% (714/1,201) patients needed IMV for the failure of HFNO and/or NIV. About 48.3, 61.6, and 63.6% of patients who were treated with HFNO, NIV, or both, respectively, needed IMV. The need of IMV was significantly lower in the HFNO group ( p <0.001). The 28-day mortality was 44.9, 59.9, and 59.6% in the patients treated with HFNO, NIV, or both, respectively ( p <0.001). On multivariate regression analysis, presence of any comorbidity, SpO 2 <90%, and presence of nonrespiratory organ dysfunction were independent and significant determinants of mortality ( p <0.05). Conclusions During COVID-19 pandemic surge, HFNO and/or NIV could successfully avoid IMV in 35.5% individuals with PO 2 /FiO 2 ratio <150. Those who needed IMV due to failure of HFNO or NIV had high (87.5%) mortality. How to cite this article Jog S, Zirpe K, Dixit S, Godavarthy P, Shahane M, Kadapatti K, et al. Noninvasive Respiratory Assist Devices in the Management of COVID-19-related Hypoxic Respiratory Failure: Pune ISCCM COVID-19 ARDS Study Consortium (PICASo). Indian J Crit Care Med 2022;26(7):791–797.
Ashbaug first described acute respiratory distress syn drome (ARDS) in 1967 [1] in patients having acute respi ratory distress, cyanosis refractory to oxygen therapy, decreased lung compliance, and diffuse infiltrates evi dent on the chest radiograph. The definitions have evolved since then to the recent most accepted one pro posed by the American-European Consensus Confer ence Committee. [2]. The definition has an advantage: it recognizes that the severity of the clinical lung injury varies; the patients with less severe hypoxemia with the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2) less than or equal to 300 are considered to have acute lung injury (ALI) and those with more severe hypoxemia with PaO 2 /FiO 2 less than or equal to 200 are considered to have ARDS. The syndrome has been frustratingly resistant to treat ment and the mortality from ARDS still remains very high. Years of clinical research have led to conceptual clarifi cation of the etiopathogenesis of the lung injury in ALI/ ARDS. Studies in experimental models strongly suggest that the traditional mechanical ventilation approaches could actually cause ventilator-induced lung injury. [3,4] Besides this, the lung injury which was believed to be diffuse and homogenous on the chest radiographs is actually patchy. [5]. There is, hence, a preferential distri bution of large tidal volumes and higher inspiratory pres sures to the normal alveoli, causing overdistension and
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