Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO2/FiO2 Ratio a Predictor of Success
| Autor: | Onkar Kumar Jha, Rajesh Gupta, Mrinal Sircar, Sunny Kumar, Saurabh Mehra |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
Mechanical ventilation
medicine.medical_specialty Univariate analysis Acute hypoxemic respiratory failure Coronavirus disease 2019 (COVID-19) business.industry medicine.medical_treatment Critical Care and Intensive Care Medicine medicine.disease Pao2 fio2 ratio Confidence interval Pneumonia Internal medicine medicine Cardiology Breathing business |
| Zdroj: | Indian Journal of Critical Care Medicine. 25:1137-1146 |
| ISSN: | 1998-359X 0972-5229 |
| DOI: | 10.5005/jp-journals-10071-23992 |
| Popis: | In acute respiratory failure due to severe coronavirus disease 2019 (COVID-19) pneumonia, mechanical ventilation remains challenging and may result in high mortality. The use of noninvasive ventilation (NIV) may delay required invasive ventilation, increase adverse outcomes, and have a potential aerosol risk to caregivers. Data of 30 patients were collected from patient files and analyzed. Twenty-one (70%) patients were weaned successfully after helmet-NIV support (NIV success group), and invasive mechanical ventilation was required in 9 (30%) patients (NIV failure group) of which 8 (26.7%) patients died. In NIV success vs failure patients, the mean baseline PaO2/FiO2 ratio (PFR) (147.2 +/- 57.9 vs 156.8 +/- 59.0 mm Hg;p = 0.683) and PFR before initiation of helmet (132.3 +/- 46.9 vs 121.6 +/- 32.7 mm Hg;p = 0.541) were comparable. The NIV success group demonstrated a progressive improvement in PFR in comparison with the failure group at 2 hours (158.8 +/- 56.1 vs 118.7 +/- 40.7 mm Hg;p = 0.063) and 24 hours (PFR-24) (204.4 +/- 94.3 vs 121.3 +/- 32.6;p = 0.016). As predictor variables, PFR-24 and change (delta) in PFR at 24 hours from baseline or helmet initiation (dPFR-24) were significantly associated with NIV success in univariate analysis but similar significance could not be reflected in multivariate analysis perhaps due to a small sample size of the study. The PFR-24 cutoff of 161 mm Hg and dPFR-24 cutoff of -1.44 mm Hg discriminate NIV success and failure groups with the area under curve (confidence interval) of 0.78 (0.62-0.95);p = 0.015 and 0.74 (0.55-0.93);p = 0.039, respectively. Helmet interface NIV may be a safe and effective tool for the management of patients with severe COVID-19 pneumonia with acute respiratory failure. More studies are needed to further evaluate the role of helmet NIV especially in patients with initial PFR |
| Databáze: | OpenAIRE |
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