Predictors of <scp>CPAP</scp> outcome in hospitalized <scp>COVID</scp>‐19 patients

Noeman-Ahmed, Yasser; Gokaraju, Sriya; Powrie, Duncan; Amran, Dora; Sayed, Iman El; Roshdy, Ashraf

doi:10.1111/resp.13964

Cited by 23 publications

(11 citation statements)

References 6 publications

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“…Initial reports of NIV use in Covid 19 showed that CPAP trial succeed in 40% when used in those requiring >15 L/min of O2 by nonrebreathing mask with baseline SpO 2 /FiO 2 (SFR) of >110, RR > 30/min and NLR > 8. Repeat SFR at 30-120 min improved in all patients but cut off of SFR 180 was the best predictor of success or failure of CPAP trial but patients who failed had high mortality (38%) [10]. Intubation rates and mortality in Covid 19 patients who received NIV was similar to the group which received HFNC.…”

Section: Niv In Covid-19 Pneumoniamentioning

confidence: 74%

Non-Invasive Ventilation in Acute Hypoxemic Respiratory Failure

Talwar¹,

Kumar²,

Talwar³

2022

ICU Management and Protocols

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Non-invasive Ventilation (NIV) has emerged as an useful aid for management of pulmonary diseases specifically in cases of respiratory failure. NIV provides respiratory support without the need of an endotracheal tube, helping in avoiding the complications associated with intubation such as tracheal trauma, infection, bleeding, injury to the lung tissues and aspiration. NIV has turned out to provide substantial benefit in the management of chronic obstructive pulmonary disease, acute respiratory distress syndrome, cardiogenic pulmonary edema and in cases of neuromuscular disorders. It has now become an integral tool in the management of respiratory failure, both at home as well as hospital settings including critical care units. All patients of respiratory failure irrespective of causes likeAcute exacerbations of COPD, Acute pulmonary edema, Exacerbations of cystic fibrosis, asthma, or restrictive lung disease and Pneumonia admitted in intensive care unit/high dependent units are suitable for NIV. Noninvasive ventilation is standard of care in chronic respiratory failure and has replaced invasive ventilation in such settings. Its flexibility in use and ease of administration allows it to be acceptable by patients as well as caregivers.

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Section: Niv In Covid-19 Pneumoniamentioning

confidence: 74%

Non-Invasive Ventilation in Acute Hypoxemic Respiratory Failure

Talwar¹,

Kumar²,

Talwar³

2022

ICU Management and Protocols

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“…The components of the A-a gradient are measures of ventilation-perfusion (VQ) mismatch, diffusion abnormalities and changes in ventilation (Co2). In ARF due to SARS-COV-2, patients present with severe hypoxemic hypocapnoeic alkalosis where it has been speculated that the PaO2/FiO2 (PF) ratio is an underestimate of hypoxaemia unlike the A-a gradient, because the PaO2 values standardised to PaCO2 levels is not calculated (1,66*PaCO2-PaO2 – 66,4 mmHg) 12,23 . We show a higher correlation between the ROX index and the A-a gradient, as opposed to the PF ratio.…”

Section: Discussionmentioning

confidence: 99%

“…The practical ease of measurement of the ROX, in contrast to arterial blood sampling makes it easy for repetitive measurements using existent observations. Previous investigators have suggested the use of the SF (SpO2/FiO2) ratio 12 which may be prone to inaccuracies of the oxygen dissociation curve with saturations < 92%. This limitation has been reported to be mitigated by the addition of the respiratory rate: the ROX index 23 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

Ghani

Shaw

Pyae

et al. 2021

Preprint

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Background: Non-invasive respiratory support including high-flow nasal oxygen (HFNO), and continuous positive airway pressure (CPAP) have been used to provide therapy in selected SARS-CoV-2 patients with acute respiratory failure (ARF). The value of the ROX index, a validated benchmark for outcomes in HFNO is unknown in CPAP. Objective: Can the ROX, a validated benchmark in HFNO be used for measuring treatment outcomes of CPAP in SARS-COV-2 ARF? Study Design and Methods: A non-randomised prospective protocol driven observational non-intensive care unit study in 130 SARS-COV-2 patients with ARF treated with non-invasive therapy from March 2020 to January 2021. The primary end point was failure of therapy (death or escalation). Secondary outcomes included time to failure including invasive mechanical ventilation (IMV) or death, the effect of escalation to CPAP from HFNO and the utility of ROX in ARF. Results: HFNO was better than CPAP in treating SARS-COV-2 ARF: 17/35 (48.5%) with successful HFNO therapy versus 24/95 (25.2%) with CPAP. The ROX index was more sensitive to outcomes with CPAP compared to HFNO and distinguished treatment failure early at 1, 4, 6, 12, and 24 hours with the highest sensitivity at 24 hours (ROX-24h). The AUC for the ROX-24h was 0.77 for HFNO (P<0.0001), and 0.84 for CPAP (P<0.0001). The ROX-24h cut-points predicted failure with HFNO when < 3.9 (PPV 71%, NPV 75%) and CPAP < 4.3 (PPV 75%, NPV 91%). For success, ROX-24h cut-points of 7.6 for HFNO (PPV 85%, NPV 48%) and 6.1 for CPAP (PPV 88%, NPV 62%) were observed. Escalation from HFNO to CPAP was mostly not successful. Conclusion: ARF in SARS-COV-2 can be successfully managed by non-invasive support. The ROX index, validated for HFNO, provides a timely, low resource measure for both HFNO and CPAP avoiding delayed intubation. Trial registration: Study approved by NHS HRAREC (20/HRA/2344;ethics 283888)

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“…In clinical trials, this efficacy is around 65-70%: 66.6% with CPAP 22 ; 65.7% with HNFC 23 ; 70% with CPAP (HENIVOT) 24 . In other observational studies, an efficacy of NIRS in avoiding OTI-IMV of around 40% is described: 37% with CPAP 18 ; 40% with CPAP 25 .…”

Section: Introductionmentioning

confidence: 88%

The RICU during the COVID Pandemic

Landete¹,

Terán-Tinedo²

2022

BRN

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The respiratory intermediate care unit (RICU) is logistically a «step up» or «step down» unit between the intensive care unit (ICU) and general hospitalization. It is efficiency in terms of «avoided cost». During the pandemic, RICU increased exponentially with the aim of avoiding ICU congestion with coronavirus disease 2019 (COVID-19) patients. These units must be attended by a multidisciplinary professional team with presence and assistance 24 hours a day and must be prepared with adequate monitoring for a quick scale in case of deterioration. The high flow nasal cannula (HFNC) increases ventilator-free days and reduces hospital stays. Awake prone position significantly reduced the incidence of treatment failure. Conscious sedation is used to increase the tolerance to non-invasive ventilation (NIV). In the treatment with HFNC, obesity, immunosuppression and elevated inflammatory markers were associated with a higher failure rate. With everything learned so far, there should be no hospital without RICU.

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Predictors of CPAP outcome in hospitalized COVID‐19 patients

Abstract: https://youtu.be/9GADRnfBHSc

Cited by 23 publications

References 6 publications

Non-Invasive Ventilation in Acute Hypoxemic Respiratory Failure

Non-Invasive Ventilation in Acute Hypoxemic Respiratory Failure

Evaluation of the ROX index in SARS-CoV-2 Acute Respiratory failure treated with both High-Flow Nasal Oxygen (HFNO) and Continuous Positive Airway Pressure (CPAP)

The RICU during the COVID Pandemic

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