Abstract
Objective
To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India.
Patients and Methods
We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of H2O, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death.
Results
In total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode.
Conclusion
Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.
【저자키워드】 acute respiratory distress syndrome, intensive care unit, High-flow nasal oxygen, Noninvasive ventilation, coronavirus disease 19, Invasive mechanical ventilation, Continuous Positive Airway Pressure, Positive end-expiratory pressure, ICUIntensive Care Unit, ARDSacute respiratory distress syndrome, PEEPpositive end-expiratory pressure, IMVInvasive mechanical ventilation, BPAPbilevel positive airway pressure, bilevel positive airway pressure, CARDScoronavirus disease 2019 acute respiratory distress syndrome, coronavirus disease 2019 acute respiratory distress syndrome, CPAPcontinuous positive airway pressure, COVID-19coronavirus disease 19, HFNOhigh-flow nasal oxygen, IPAPinspiratory positive airway pressure, inspiratory positive airway pressure, NIVnoninvasive ventilation, RIMCUrespiratory intermediate care unit, respiratory intermediate care unit, 【초록키워드】 Treatment, coronavirus disease, therapy, intensive care, hospital, India, Comorbidities, intubation, outcome, hypertension, Cohort, management, Patient, death, age, respiratory, Care, acute respiratory distress, Escalation, Respiratory Support, positive airway pressure, Support, study period, syndrome, positive, low-flow oxygen, Administered, resources, NIV, men, objective, effective, benefit, Result, defined, required, treated, added, hospitalized patient, commenced, 【제목키워드】 COVID-19, respiratory, Device, unit, intermediate,