Optimizing respiratory management in resource-limited settings

Inglis, Rebecca; Ayebale, Emmanuel Timarwa; Schultz, Marcus J.

doi:10.1097/mcc.0000000000000568

Cited by 35 publications

(39 citation statements)

References 46 publications

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“…Concrete examples include the frequent need to reuse single-use components, poor access to consumables-including heat and moisture exchangers and suction catheters, poor access to spare ventilator parts like flow meters, unreliable oxygen supply, and inconsistent electricity. 25 Novel coronavirus disease-specific infection prevention and control issues include the lack of close circuit endotracheal suction and absent or poor-quality heat moisture exchange filters with viral filtration capability. Particular in combination with poor availability of PPE, these shortcomings can pose an unacceptable risk to healthcare staff and should thus be addressed when countries aim for bolstering their mechanical ventilation capacity.…”

Section: Introductionmentioning

confidence: 99%

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Dondorp

Hayat

Aryal³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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179

163

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The ongoing novel coronavirus disease pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival. Although our knowledge of the disease is still rapidly increasing, this review summarizes current guidance on the best provision of ventilatory support, with a focus on resource-limited settings. Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia and should be a primary focus in resource-limited settings where capacity for invasive ventilation is limited. Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning.The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential. Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome, and limiting the positive endexpiratory pressure level on the ventilator may be important. This ventilation strategy might reduce the currently very high case fatality rate of more than 50% in invasively ventilated COVID-19 patients.

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Section: Introductionmentioning

confidence: 99%

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Dondorp

Hayat

Aryal³

et al. 2020

The American Journal of Tropical Medicine and Hygiene

Self Cite

179

163

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“…Limitations regarding awake proning in LMICs include a lack of human resources, training, and challenges with infrastructure and equipment. 49 The group recognizes the limitation of staffing in many LMICs and that a "proning team" may not always be feasible. The guidance by one trained healthcare professional, or two in an obese or a noncooperative patient, however, is seen as one minimal requirement to proceed with this intervention.…”

Section: Expert Opinionmentioning

confidence: 99%

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

Stilma

Åkerman

Artigas

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Non-intubated patients with acute respiratory failure due to COVID-19 could benefit from awake proning. Awake proning is an attractive intervention in settings with limited resources, as it comes with no additional costs. However, awake proning remains poorly used probably because of unfamiliarity and uncertainties regarding potential benefits and practical application. To summarize evidence for benefit and to develop a set of pragmatic recommendations for awake proning in patients with COVID-19 pneumonia, focusing on settings where resources are limited, international healthcare professionals from high and low- and middle-income countries (LMICs) with known expertise in awake proning were invited to contribute expert advice. A growing number of observational studies describe the effects of awake proning in patients with COVID-19 pneumonia in whom hypoxemia is refractory to simple measures of supplementary oxygen. Awake proning improves oxygenation in most patients, usually within minutes, and reduces dyspnea and work of breathing. The effects are maintained for up to 1 hour after turning back to supine, and mostly disappear after 6–12 hours. In available studies, awake proning was not associated with a reduction in the rate of intubation for invasive ventilation. Awake proning comes with little complications if properly implemented and monitored. Pragmatic recommendations including indications and contraindications were formulated and adjusted for resource-limited settings. Awake proning, an adjunctive treatment for hypoxemia refractory to supplemental oxygen, seems safe in non-intubated patients with COVID-19 acute respiratory failure. We provide pragmatic recommendations including indications and contraindications for the use of awake proning in LMICs.

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“…Challenges in safely treating patients with tracheostomy in low-resource settings include staff training, inadequate PPE, insufficient functioning ventilators or repairs, lack of medical oxygen, short supply of suction devices, and reliance on nonsterile suction catheters that are washed and reused between patients. [113][114][115][116][117][118] Despite these constraints, remarkable ingenuity by critical care nurses and hospitals allows most evidencebased recommendations presented herein to be tailored for implementation within local protocols, 119 with notable caveats in conventional sterilization techniques, limited testing, and lack of isolation rooms. [120][121][122] Examples of ingenuity include gloves made from plastic materials melted in home-made heated molds, cutting 5-gallon water bottles into vented full-coverage face shields, and evidence-based substitution for infection control (eg, soaking used gloves in special available detergents).…”

Section: Considerations For Low-resource Health Systemsmentioning

confidence: 99%

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Pandian

Morris

Brodsky

et al. 2020

American Journal of Critical Care

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Purpose Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Methods Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Results Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Conclusion Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

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Optimizing respiratory management in resource-limited settings

Cited by 35 publications

References 46 publications

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Respiratory Support in COVID-19 Patients, with a Focus on Resource-Limited Settings

Awake Proning as an Adjunctive Therapy for Refractory Hypoxemia in Non-Intubated Patients with COVID-19 Acute Respiratory Failure: Guidance from an International Group of Healthcare Workers

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

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