Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis

Cardona, Stephanie; Downing, Jessica; Alfalasi, Reem; Bzhilyanskaya, Vera; Milzman, David; Rehan, Mehboob; Schwartz, Bruce A.; Yardi, Isha; Yazdanpanah, Fariba; Tran, Quincy

doi:10.1016/j.ajem.2021.01.058

Cited by 39 publications

(40 citation statements)

References 60 publications

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“…In a review study by da Silva et al, intubation need vary from 42% to 47% (68). Besides, Cardona et al reported that the intubation rate was 28% among hypoxic COVID-19 patients (69). This discrepancy in statistics may be due to the variety of study populations, study environments, or intubation criteria.…”

Section: Discussionmentioning

confidence: 99%

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

2021

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Background: Severe coronavirus disease 2019 (COVID-19) can induce acute respiratory distress, which is characterized by tachypnea, hypoxia, and dyspnea. Intubation and mechanical ventilation are strategic treatments for COVID-19 distress or hypoxia. Methods: We searched PubMed, Embase, and Scopus databases to identify relevant randomized control trials, observational studies, and case series published from April 1, 2021. Results: 24 studies were included in this review. Studies had been conducted in the USA, China, Spain, South Korea, Italy, Iran, and Brazil. Most patients had been intubated in the intensive care unit. Rapid sequence induction had been mostly used for intubation. ROX index can be utilized as the predictor of the necessity of intubation in COVID-19 patients. According to the studies, the rate of intubation was 5 to 88%. It was revealed that 1.4 - 44.5% of patients might be extubated. Yet obesity and age (elderly) are the only risk factors of delayed or difficult extubation. Discussion and Conclusions: Acute respiratory distress in COVID-19 patients could require endotracheal intubation and mechanical ventilation. Severe respiratory distress, loss of consciousness, and hypoxia had been the most important reasons for intubation. Also, increased levels of C-reactive protein (CRP), ferritin, d-dimer, and lipase in combination with hypoxia are correlated with intubation. Old age, diabetes mellitus, respiratory rate, increased level of CRP, bicarbonate level, and oxygen saturation are the most valuable predictors of the need for mechanical ventilation. ICU admission mortality following intubation was found to be 15 to 36%. Awake-prone positioning in comparison with high-flow nasal oxygen therapy did not reduce the risk of intubation and mechanical ventilation. There was no association between intubation timing and mortality of the infected patients. Noninvasive ventilation may have survival benefits.

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Section: Discussionmentioning

confidence: 99%

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

2021

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“…In the review study by da Silva CM et al, intubation need vary from 2, 3, 4, to 42% and 47% [55]. Besides, Cardona et al reported that the intubation rate was 28% among hypoxic COVID-19 patients [56]. This discrepancy in statistics may be due to the variety of study population, study environment, or intubation criteria.…”

Section: Discussionmentioning

confidence: 99%

Invasive airway “Intubation” in COVID-19 patients :statistics, causes and recommendations

Mohammadi

Khamseh

Varpaei

2021

Preprint

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Background: Severe COVID-19 disease could induce acute respiratory distress which is characterized by tachypnea, hypoxia, and dyspnea. Intubation and mechanical ventilation are a strategic treatment of COVID-19 distress or hypoxia. Methods: We searched PubMed, Embase, and Scopus databases through April 1, 2021, to identify relevant randomized control trials, observational studies, and case series. Results: 24 studies were included in this review. Studies were conducted in the USA, China, Spain, South Korea, Italy, Iran, and Brazil. Most patients were intubated in the intensive care unit. Rapid sequence induction was mostly used for intubation. ROX index might be utilized for the predictor of the necessity of intubation in COVID-19 patients. According to the previous studies the rate of intubation reported 5 to 88%. It was revealed that 1.4 - 44.5% of patients might be extubated. Yet obesity and age (elderly) are the only risk factors of delayed or difficult extubation. Discussion and conclusion: Acute respiratory distress in COVID-19 patients could require endotracheal intubation and mechanical ventilation. Severe respiratory distress, loss of consciousness, and hypoxia were the most important reasons for intubation. Also, increased levels of ferritin, d-dimer, and lipase in common with hypoxia are correlated with intubation and ICU admission Mortality following intubation is reported to be 15 to 36%. Awake-prone positioning in comparison to high-flow nasal oxygen therapy did not reduce the risk of intubation and mechanical ventilation. There was no association between intubation timing and mortality of infected patients. noninvasive ventilation may have survival benefits. Keywords: Intubation, COVID-19, critical care, respiratory disease, infectious disease, hypoxia, airway management.

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“…Oxygenation improvement was sustained after re-supination in patients in whom the prone position was combined with noninvasive respiratory strategies (HFNO or NIV) [ 117 , 126 ]. Overall, around 28% of patients eventually required invasive MV [ 131 , 132 , 133 ]. It remains inconclusive whether awake self-proning had an effect on intubation and mortality.…”

Section: Prone Position During High-flow Nasal Oxygen or Noninvasive Ventilation In Patients With Covid-19mentioning

confidence: 99%

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

Akoumianaki

Ischaki

Karagiannis

et al. 2021

JPM

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Acute hypoxemic respiratory failure is the principal cause of hospitalization, invasive mechanical ventilation and death in severe COVID-19 infection. Nearly half of intubated patients with COVID-19 eventually die. High-Flow Nasal Oxygen (HFNO) and Noninvasive Ventilation (NIV) constitute valuable tools to avert endotracheal intubation in patients with severe COVID-19 pneumonia who do not respond to conventional oxygen treatment. Sparing Intensive Care Unit beds and reducing intubation-related complications may save lives in the pandemic era. The main drawback of HFNO and/or NIV is intubation delay. Cautious selection of patients with severe hypoxemia due to COVID-19 disease, close monitoring and appropriate employment and titration of HFNO and/or NIV can increase the rate of success and eliminate the risk of intubation delay. At the same time, all precautions to protect the healthcare personnel from viral transmission should be taken. In this review, we summarize the evidence supporting the application of HFNO and NIV in severe COVID-19 hypoxemic respiratory failure, analyse the risks associated with their use and provide a path for their proper implementation.

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Intubation rate of patients with hypoxia due to COVID-19 treated with awake proning: A meta-analysis

Cited by 39 publications

References 60 publications

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

Invasive airway “Intubation” in COVID-19 patients :statistics, causes and recommendations

The Role of Noninvasive Respiratory Management in Patients with Severe COVID-19 Pneumonia

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