Friday , March 5 2021

How to effectively fight respiratory failure in COVID-19 patients



A respiratory therapist assists a patient with COVID-19 in Los Angeles, USA
Breathing Therapist Assists Patient with COVID-19 in Los Angeles, USA – REUTERS / Lucy Nicholson

God Acute respiratory failure is a major cause of death in COVID-19 patients. Non-Invasive Breathing Strategies (NIRS) They are widely used in these patients to save their lives. According to experts, the NIRS technique may reduce the need for invasive mechanical ventilation (IMV) in patients with acute respiratory failure, but patients who do not respond to NIRS have poor results.

This lack of response can be particularly Is important in patients with COVID-19, as health care availability may be limited during the epidemic. Therefore, early detection of COVID-19 patients who are unlikely to respond to NIRS treatment would be helpful.

Previous studies in patients with other respiratory conditions Reported low pH, low Glasgow score, and low oxidation, And high heart rate, high respiration rate, and tidal volume are associated with NIV failure.

Mexican paramedic takes a break after a hard day working against the plague - REUTERS / Luis Corts
Mexican paramedic takes a break after a hard day working against the plague – REUTERS / Luis Corts

Similarly, a number of clinical and oxidative variables, including a lack of clinical improvement in oxidation or decreased respiratory rate, have been linked to HFNC failure and subsequent need for IMV. However, most of these variables were of limited value in identifying patients who would require subsequent intubation. In patients with acute respiratory failure and pneumonia, the respiratory-oxygen index (ROX), based on oxygen saturation measured by oximetry pulse (SpO 2), inspired oxygen fraction (FiO 2) and respiratory rate, can help identify risk for intubation and failure of the – NIRS.

However, it is not known which indicators are useful in identifying COVID-19 patients at high risk for NIRS failure. The aim of the study was to develop and validate a simple nomogram and online calculator to predict the risk of NIRS failure in COVID-19 patients. Who have acute respiratory failure. In a study conducted by professionals from Zhongda Hospital at the University of Southeast China, they developed and validated an online numerogram and calculator for early prediction of NIRS failure in COVID-19 patients.

Test cure

NIRS technique may reduce the need for invasive mechanical ventilation (IMV) in patients with acute respiratory failure - REUTERS / Go Nakamura
NIRS technique may reduce the need for invasive mechanical ventilation (IMV) in patients with acute respiratory failure – REUTERS / Go Nakamura

Nomogram, based on age, comorbidity number, ROX index, score of Glasgow coma and use of Vesoporsor on the first day of NIRS, Has a discriminatory ability of 95 in predicting failures in NIRS. Patients in whom NIRS fails are at high risk of death. Thus, early prediction of NIRS failure can help physicians properly allocate critical care resources and identify high-risk patients for clinical trials.

In non-COVID-19 respiratory conditions, several studies have shown that intubation after initial use of NIV or HFNC is associated with worse outcomes, such as increased mortality, in patients with acute respiratory failure. Predicting the outcome of NIRS is especially important among COVID-19 patients, given the limited resources available during the epidemic.

although Previous studies have shown that the criteria for initiating HFNC or VIN and their results may be different, they found that most independent risk factors for NIRS failure overlap in the HFNC and VIN groups in the. In fact, 26% received HFNC and NIV at different periods during their illness. They verified a prediction scale for NIV failure in non-COVID-19 patients (based on pulse, acidity, awareness, oxidation, and respiration rate).

In non-COVID-19 respiratory conditions, several studies have shown that intubation after initial use of NIV or HFNC is associated with worse outcomes - REUTERS / Shannon Stapleton
In non-COVID-19 respiratory conditions, several studies have shown that intubation after initial use of NIV or HFNC is associated with worse outcomes – REUTERS / Shannon Stapleton

The study showed that NIRS failed in 64% of cases in the training group and in 69% of cases in the external validation group; These values ​​are higher than the previously reported failure rate for HFNC (28-38%) and NIV (39-50%). Mortality over 28 days in external training and validation groups was 54% and 63%, respectively, in the range of 16-78% previously described in patients with COVID-19 admitted to intensive care.

However, patients in whom NIRS failed had significantly higher mortality than previously reported in other respiratory states after failure of VIN or HFNC. To make the prediction model simple and quick to use in the clinical setting, the experts focused only on risk factors that did not require laboratory parameters.

In conclusionAn online numerogram and calculator is easy to use and can predict the risk of failure in COVID-19 patients treated with HFNC and NIV. Both can be used to identify patients with a high probability of NIRS failure. These patients can benefit from earlier three and more intensive follow-up. The benefits of such a strategy, which can include early intubation, will require approval in randomized controlled trials.

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