Our Success in the Treatment of Acute Respiratory Failure in Coronovirus Patients Using Non-invasive Ventilation

Abstract

The novel coronavirus infection (COVID-19) pandemic, caused by the highly contagious severe acute respiratory syndrome coronavirus (SARS-CoV-2), is still at its peak, causing thousands of deaths every week. Since the beginning of the coronavirus (just a few months ago), our understanding of the disease has grown rapidly. While there are several large randomized drug trials currently underway, current survival from severe COVID-19 is entirely dependent on providing the best supportive care possible. To determine the benefits of NIV in ARF in patients with COVID-19. The study included 25 patients admitted to the intensive care unit of the AMU surgical clinic during the period from April 1 to August 1, 2020. Our experience with NIV has shown that the majority of patients undergoing NIV tolerate this procedure relatively well at the initial stage. However, in a number of patients during the first minutes or hours of NIV, there is no improvement in their condition (clinical parameters and gas exchange) or the procedure is poorly tolerated; the proportion of such patients is usually about 15–35%. Non-invasive ventilation of the lungs was carried out with an oral-nasal mask using an ELISA ventilator. The parameters were set and adjusted according to the general state and according to blood gas data 4 times a day: RR <35, pH> 7.30, neurological dysfunction according to the Kelly scale> 3-5, modified with a scale for determining the participation of auxiliary respiratory muscles <3 points. With hypercapnia, the following parameters were set: Ps – 12, PEEP – 6 cm water column, FiO2 -30-40%, and with hypoxemia – Ps – 12, PEEP – 5 cm water column, FiO2 -50-60 %. The median treatment period with NIV was 12 days. The average daily treatment time with NIV on the first day was 16.5 hours, on the second day – 17.2 hours and on the third day 15.7 hours. The patient was discharged on the 18th day with improvement.