Feasibility of Noninvasive Positive Pressure Ventilation in the Treatment of Oxygen-Dependent COVID-19 Patients in Peru

Abstract

Intensive care is expensive, and availability is limited. Low- and middle-income countries in particular have struggled to cope with the large influx of critically ill patients during the COVID-19 pandemic. Noninvasive respiratory support devices delivering continuous positive airways pressure (CPAP) require less resource and staff expertise compared with invasive mechanical ventilators and can be routinely used outside of intensive care units. This study assessed the use of the UCL-Ventura Wayrachi CPAP device in hospitalized patients with COVID-19 in Peru. A secondary analysis of data collected for a feasibility study commissioned by the Peruvian Ministry of Health was conducted. Data were collected from three hospitals, including patient demographics, clinical data, and outcomes. Forty-five patients were enrolled from July 16 to September 1, 2020. Eight patients (18%) were intolerant of the CPAP mask. Of the remainder, 18 (48.7%) improved and were discharged from hospital after 6 days. Eight (21.6%) died while on CPAP and 11 (29.7%) were eventually intubated, of whom two died. In total, 27 (60%) survived to hospital discharge. Participating physicians noted the device was easy to use and provided patient benefit, though voiced concerns about the strain on hospital oxygen supplies. In conclusion, the UCL Ventura Wayrachi CPAP device proved feasible in COVID-19 patients in Peru, and offered a bridging therapy for patients who required a ventilator when none were available.

Use of a Gas-Operated Ventilator as a Noninvasive Bridging Respiratory Therapy in Critically Ill COVID-19 Patients in a Middle-Income Country

“…Carcamo et al performed a feasibility study involving 45 COVID-19 patients who had previously required high-concentration oxygen (15L/min). They used the UCL-Ventura "Wayrachi CPAP", which was reverseengineered from the Phillips Respironics™ whisper ow device [33]. In that study, the UCL-Ventura device was successfully used as a noninvasive bridging respiratory therapy to IMV in 30% of patients, which is substantially lower than the 58% success rate in our study.…”

Dispositivos médicos en tiempos de pandemia: Eficacia de un sistema artesanal de alto flujo en el manejo de pacientes hospitalizados por COVID-19

“…En el presente estudio, se presentan los resultados de seguimiento de una muestra de 202 pacientes hospitalizados con COVID-19 con tratamiento de terapia de presión positiva continua en las vías respiratorias manejados con Wayrachi y Cánula de Alto Flujo (CAF); cabe mencionar que a la fecha, es el estudio comparativo de ventiladores con mayor número de pacientes hospitalizados con COVID-19; así en un estudio previo realizado en Perú, se analizó data de 45 pacientes hospitalizados con COVID-19, que utilizaron el dispositivo CPAP UCL-Ventura Wayrachi. [22] El Wayrachi presentó resultados similares al CAF en función a indicadores de sobrevivencia y de fallecimiento, con lo que se demostraría que el dispositivo Wayrachi podría ser utilizado con una eficacia similar a equipos comerciales en pacientes hipoxémicos con COVID-19 cuando no se encuentren disponibles opciones comerciales. Este manejo se podría dar para tratamiento alternativo sin ventilación invasiva o como terapia puente hasta la liberación de ventiladores o de camas UCI, como sucedió en esta pandemia.…”

“…Dicho estudio además concluye que los médicos que utilizaron los Wayrachis, lo calificaron como un dispositivo de uso fácil y beneficioso para estos pacientes. [22] Nuestro estudio encontró una diferencia no significativa entre los "días de enfermedad antes de acudir al hospital" para…”

“…Si bien existen estudios que brindan información acerca de la eficacia de este tipo de intervenciones, estas se han realizado con números pequeños de participantes por lo que sus hallazgos deben ser corroborados, sobre todo en distintas poblaciones y realidades. [13][14][15][16] El presente estudio analizó la eficacia del dispositivo artesanal de asistencia respiratoria no invasivo de administración de presión positiva continua en las vías respiratorias (CPAP) Wayrachi en comparación con la cánula de alto flujo (CAF) comercial para el tratamiento de pacientes con SARS-CoV-2.…”

Effect of the modified snorkel mask as noninvasive ventilatory support in patients with acute hypoxemic respiratory failure due to COVID-19

“…5 Different types of noninvasive devices are used to treat ARDS related to COVID-19. These include high-flow nasal cannula, 6 the helmet, 7 the Wayrachi nasal continuous positive airway pressure device (NCPAP), 8 and the modified snorkel mask. 9,10 These devices are used in patients with ARDS who failed to improve with conventional oxygen therapy methods such as the venturi system or the reservoir mask and could not be admitted to the Intensive Care Unit (ICU) due to bed availability.…”