Continuous positive airway pressure for respiratory support during COVID-19 pandemic: a frugal approach from bench to bedside

Autor: Guillaume Carteaux, Manuella Pons, François Morin, Samuel Tuffet, Arnaud Lesimple, Bilal Badat, Anne-Fleur Haudebourg, François Perier, Yvon Deplante, Constance Guillaud, Frédéric Schlemmer, Elena Fois, Nicolas Mongardon, Mehdi Khellaf, Karim Jaffal, Camille Deguillard, Philippe Grimbert, Raphaëlle Huguet, Keyvan Razazi, Nicolas de Prost, François Templier, François Beloncle, Alain Mercat, Laurent Brochard, Vincent Audard, Pascal Lim, Jean-Christophe Richard, Dominique Savary, Armand Mekontso Dessap
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Annals of Intensive Care, Vol 11, Iss 1, Pp 1-14 (2021)
Druh dokumentu: article
ISSN: 2110-5820
DOI: 10.1186/s13613-021-00828-2
Popis: Abstract Background We describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19 patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter (“Filter Frugal CPAP”, FF-CPAP) in and out the ICU. Methods (1) A bench study measured the impact of two filters with different mechanical properties on CPAP performances, and pressures were also measured in patients. (2) Non-ICU healthcare staff working in COVID-19 intermediate care units were trained with a video tutorial posted on a massive open online course. (3) A clinical study assessed the feasibility and safety of using FF-CPAP to maintain oxygenation and manage patients out of the ICU during a massive outbreak. Results Bench assessments showed that adding a filter did not affect the effective pressure delivered to the patient. The resistive load induced by the filter variably increased the simulated patient’s work of breathing (6–34%) needed to sustain the tidal volume, depending on the filter’s resistance, respiratory mechanics and basal inspiratory effort. In patients, FF-CPAP achieved pressures similar to those obtained on the bench. The massive training tool provided precious information on the use of Boussignac FF-CPAP on COVID-19 patients. Then 85 COVID-19 patients with ICU admission criteria over a 1-month period were studied upon FF-CPAP initiation for AHRF. FF-CPAP significantly decreased respiratory rate and increased SpO2. Thirty-six (43%) patients presented with respiratory indications for intubation prior to FF-CPAP initiation, and 13 (36%) of them improved without intubation. Overall, 31 patients (36%) improved with FF-CPAP alone and 17 patients (20%) did not require ICU admission. Patients with a respiratory rate > 32 breaths/min upon FF-CPAP initiation had a higher cumulative probability of intubation (p
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