How severe COVID-19 infection is changing ARDS management

Ferguson, Niall D.; Pham, Tài; Gong, Michelle N.

doi:10.1007/s00134-020-06245-6

Cited by 17 publications

(12 citation statements)

References 18 publications

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“…Acute hypoxemic respiratory failure (AHRF) accounts for a prominent number of intensive care unit (ICU) admissions worldwide [ 1 ], as dramatically highlighted by the ongoing novel coronavirus disease 2019 (COVID-19) pandemic [ 2 – 4 ]. Direct or indirect lung injury accounts for essentially all causes of acute hypoxemic respiratory failure through different pathophysiological pathways.…”

Section: Introductionmentioning

confidence: 99%

Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS

et al. 2021

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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. The oxygenation improvement coupled with lung and diaphragm protection produced by non-invasive support may help to avoid endotracheal intubation, which prevents the complications of sedation and invasive mechanical ventilation. However, spontaneous breathing in patients with lung injury carries the risk that vigorous inspiratory effort, combined or not with mechanical increases in inspiratory airway pressure, produces high transpulmonary pressure swings and local lung overstretch. This ultimately results in additional lung damage (patient self-inflicted lung injury), so that patients intubated after a trial of noninvasive support are burdened by increased mortality. Reducing inspiratory effort by high-flow nasal oxygen or delivery of sustained positive end-expiratory pressure through the helmet interface may reduce these risks. In this physiology-to-bedside review, we provide an updated overview about the role of noninvasive respiratory support strategies as early treatment of hypoxemic respiratory failure in the intensive care unit. Noninvasive strategies appear safe and effective in mild-to-moderate hypoxemia (PaO 2 /FiO 2 > 150 mmHg), while they can yield delayed intubation with increased mortality in a significant proportion of moderate-to-severe (PaO 2 /FiO 2 ≤ 150 mmHg) cases. High-flow nasal oxygen and helmet noninvasive ventilation represent the most promising techniques for first-line treatment of severe patients. However, no conclusive evidence allows to recommend a single approach over the others in case of moderate-to-severe hypoxemia. During any treatment, strict physiological monitoring remains of paramount importance to promptly detect the need for endotracheal intubation and not delay protective ventilation.

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Section: Introductionmentioning

confidence: 99%

Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS

et al. 2021

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“…The treatment basis for moderate-severe ARDS secondary to COVID-19 is based on ventilatory support with low tidal volumes, a prone position, and active management of intravenous fluids 19,20,35,36 . In this way, it is evident that the strategy The ventilator used for both groups in the present study was protective and up to 79.1% of patients complied with the prone position.…”

Section: Discussionmentioning

confidence: 99%

High-altitude is associated with better short-term survival in critically ill COVID-19 patients admitted to the ICU

Jaramillo¹,

Simbaña-Rivera

Silva

et al. 2021

Preprint

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BackgroundThe novel human coronavirus, SARS-CoV-2, has affected at least 218 countries worldwide. Some geographical and environmental factors are positively associated with a better or worse prognosis concerning COVID-19 disease and with lower or higher SARS-CoV-2 transmission. High altitude exposure has been associated with lower SARS-CoV-2 attack rates; nevertheless, the role of chronic high-altitude exposure on the clinical outcome of critically ill COVID-19 patients has not been studied.ObjectiveTo compare the clinical course and outcomes of critically ill patients with COVID-19 hospitalized in two intensive care units (ICU) located at low and high altitude.Exposure and OutcomeTo explore the effect of two different elevations (10 m vs 2,850 m above sea level) on COVID-19 clinical outcome and survival.MethodsA prospective cohort, two-center study in confirmed COVID-19 adult patients admitted to a low altitude (Sea level) and high altitude (2,850 m) ICU units in Ecuador was conducted. Two hundred and thirty confirmed COVID-19 patients were enrolled from March 15th to July 15th, 2020. Sociodemographic, clinical, laboratory and imaging parameters including supportive therapies, pharmacological treatments and medical complications were reported and compared between the low and high-altitude groups.ResultsThe median age of all the patients was 60 years, 64.8% were men and 35.2% were women. A total of 105 (45.7%) patients had at least one underlying comorbidity, the most frequent being chronic diseases, such as hypertension (33.5%), diabetes (16.5%), and chronic kidney failure (5.7%). The APACHE II scale at 72 hours was especially higher in the low-altitude group with a median of 18 points (IQR: 9.5-24.0), compared to 9 points (IQR: 5.0-22.0) obtained in the group of high altitude. There is evidence of a difference in survival in favor of the high-altitude group (p = 0.006), the median survival being 39 days, compared to 21 days in the low altitude group.ConclusionThere has been a substantial improvement in survival amongst people admitted to the high-altitude critical care unit. High altitude living was associated with improved survival, especially among patients with no comorbidities. COVID-19 patients admitted to the high-altitude ICU unit have improved severity-of-disease classification system scores at 72 hours and reported better respiratory and ventilatory profiles than the low altitude group.

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“…There are several outstanding questions on the best supportive respiratory care for patients with COVID-19 and other RVIs, including the role of high-flow nasal oxygen (HFNO) and noninvasive ventilation (NIV), awake proning, the timing of intubation and the risks of delaying intubation, extracorporeal membrane oxygenation (ECMO) and invasive ventilation strategies [13][14][15]. RCTs (RECOVERY and COVIDICUS, NCT04344730, COVI-PRONE NCT04350723, Helmet-COVID NCT04477668 and others) are awaited.…”

Section: Respiratory Supportmentioning

confidence: 99%