Conservative management of COVID-19 associated hypoxaemia

Voshaar, Thomas; Stais, Patrick; Köhler, Dieter; Dellweg, Dominic

doi:10.1183/23120541.00026-2021

Cited by 26 publications

(22 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Taken together, the results show a good agreement between the clinical and epidemiological approach (37) and provide further evidence that the high CFR in some German hospitals is caused by overtreatment (2), (38). As randomized clinical trials are largely impossible, also routinely collected data (39) are sufficient proof of the clinical observation that less invasive measures like HFNC could reduce the undoubtedly high CFR in ventilated COVID-19 patients.…”

Section: Discussionsupporting

confidence: 53%

High Variability of COVID-19 Case Fatality Rate in Germany

Wendtner

2021

SSRN Journal

View full text Add to dashboard Cite

During the first wave of the COVID-19 pandemic high case fatality rates (CFR) were noticed.Due to the dire consequences WHO guidelines recommended immediate intubation for patients with dyspnoea which has since been questioned after reviewing the initial clinical outcome.Methods: PCR confirmed infection rates along with mortality data was obtained for all German districts from 27 Jan 2020 until 15 Feb 2021 using official data sources. A moving average CFRt was constructed by dividing disease related deaths two weeks after a given index days by the number of infections two weeks prior to that date. In addition to an international comparison, mortality data between the second and third largest German cities were also compared.Results: Mean CFR is estimated to be 2.92 based on 71.965 fatalities and 2.465.407 cases.

show abstract

Section: Discussionsupporting

confidence: 53%

High Variability of COVID-19 Case Fatality Rate in Germany

Wendtner

2021

SSRN Journal

View full text Add to dashboard Cite

show abstract

“…The positive SARS-CoV-2 laboratory result occurred within 48 h of admission. We included hypoxemic patients with SpO2 ≤ 93% [13][14][15] at the start of respiratory intervention who were more likely to receive ventilation, particularly MV, and benefit from therapeutic ventilation than those with normal oxygen levels. In addition, patients without any recorded SpO2 measurement or respiratory intervention were excluded.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19

et al. 2021

View full text Add to dashboard Cite

Purpose Limited mechanical ventilators (MV) during the Coronavirus disease (COVID-19) pandemic have led to the use of non-invasive ventilation (NIV) in hypoxemic patients, which has not been studied well. We aimed to assess the association of NIV versus MV with mortality and morbidity during respiratory intervention among hypoxemic patients admitted with COVID-19. Methods We performed a retrospective multi-center cohort study across 5 hospitals during March-April 2020. Outcomes included mortality, severe COVID-19-related symptoms, time to discharge, and final oxygen saturation (SpO2) at the conclusion of the respiratory intervention. Multivariable regression of outcomes was conducted in all hypoxemic participants, 4 subgroups, and propensity-matched analysis. Results Of 2381 participants with laboratory-confirmed SARS-CoV-2, 688 were included in the study who were hypoxemic upon initiation of respiratory intervention. During the study period, 299 participants died (43%), 163 were admitted to the ICU (24%), and 121 experienced severe COVID-19-related symptoms (18%). Participants on MV had increased mortality than those on NIV (128/154 [83%] versus 171/534 [32%], OR = 30, 95% CI 16-60) with a mean survival of 6 versus 15 days, respectively. The MV group experienced more severe COVID-19-related symptoms [55/154 (36%) versus 66/534 (12%), OR = 4.3, 95% CI 2.7-6.8], longer time to discharge (mean 17 versus 7.1 days), and lower final SpO2 (92 versus 94%). Across all subgroups and propensity-matched analysis, MV was associated with a greater OR of death than NIV. Conclusions NIV was associated with lower respiratory intervention mortality and morbidity than MV. However, findings may be liable to unmeasured confounding and further study from randomized controlled trials is needed to definitively determine the role of NIV in hypoxemic patients with COVID-19. Keywords COVID-19 • SARS-CoV-2 • Non-invasive ventilation • Mechanical ventilation • Critical care outcomes Abbreviations ICU Intensive care unit MV Mechanical ventilation NIV Non-invasive ventilation SD Standard deviation COVID-19 Coronavirus disease OR Odds ratio RCT Randomized controlled trial * Ron Do

show abstract

“…Aus diesem Grund könnte der Bestimmung des CaO 2 (Sauerstoffgehalt) oder sogar der Sauerstoff Delivery (DO 2 ) eine besondere Bedeutung zukommen. Eine erste Arbeit aus Deutschland hat den CaO 2 bereits in die Therapieentscheidung integriert [14]. Ob sich hierdurch allerdings Vorteile im Vergleich zu den Leitlinien-Kriterien [4] ergeben, bleibt noch unklar.…”

Section: Studienlageunclassified

Bedeutung nicht-invasiver Verfahren in der Therapie des akuten hypoxämischen Versagens bei COVID-19

et al. 2021

View full text Add to dashboard Cite

ZusammenfassungIn der Corona-Pandemie werden zunehmend nicht-invasive Verfahren zur Behandlung des akuten hypoxämischen Versagens bei COVID-19 eingesetzt. Hier stehen mit der HFOT (high-flow oxygen therapy), CPAP (continuous positive airway pressure) und der NIV (non-invasive ventilation) unterschiedliche Verfahren zur Verfügung, die das Ziel einer Intubationsvermeidung verfolgen. Der aktuelle Übersichtsartikel fasst die heterogene Studienlage zusammen. Wesentlich ist die Erkenntnis, dass diese nicht-invasiven Verfahren durchaus auch bei einem schweren, akuten hypoxämischen Versagen erfolgreich sein können und damit die Intubation wie auch Tubus-assoziierte Komplikationen vermeiden können. Demgegenüber bleibt aber ebenso zu betonen, dass die prolongierte unterstützte Spontanatmung ebenfalls zu Komplikationen führt und dass demzufolge insbesondere ein spätes NIV-Versagen mit erheblich verschlechterter Prognose einhergeht, was vor dem Hintergrund weiterhin hoher NIV-Versagensraten in Deutschland bedeutsam ist. Der aktuelle Artikel verweist schließlich auch auf einen Parallelartikel in dieser Ausgabe, der die medial in der Öffentlichkeit in Deutschland geführte Debatte zu diesem Thema aufgreift und deren inhaltliche Fragwürdigkeit, aber auch die negativen Auswirkungen auf die Gesellschaft und die Fachwelt adressiert. Gleichzeitig wird die Bedeutung von regelmäßig zu überarbeitenden Leitlinien untermauert.

show abstract

Conservative management of COVID-19 associated hypoxaemia

Cited by 26 publications

References 38 publications

High Variability of COVID-19 Case Fatality Rate in Germany

High Variability of COVID-19 Case Fatality Rate in Germany

Non-invasive ventilation versus mechanical ventilation in hypoxemic patients with COVID-19

Bedeutung nicht-invasiver Verfahren in der Therapie des akuten hypoxämischen Versagens bei COVID-19

Contact Info

Product

Resources

About