The lack of mechanical ventilators for patients with COVID-19 has necessitated the use of other noninvasive ventilation (NIV) systems. One of these NIV systems is the use of an adapted snorkel mask ...with inspiration valves and pressure valve (PEEP).
A 48-year-old man with no previous history of lung disease was admitted to the emergency room with a diagnosis of acute respiratory failure due to SARS-COV2. The patient did not improve saturation with the use of the reservoir mask. Oxygenation was started using an adapted snorkel mask with a PEEP valve with an alveolar recruitment function and double oxygen flow. The patient presented clinical and radiological improvement after 2 days of use and was discharged 16 days later.
The use of a snorkel mask is an important, viable, and simpler NIV modality for the management of patients with COVID-19 with respiratory failure who fail to use a reservoir mask, and it can be an alternative before the use of a mechanical ventilator.
The use of the adapted snorkel mask with Charlotte valve and PEEP is a feasible alternative for the treatment of patients with COVID-19.
Tracheostomy in the COVID-19 pandemic Mattioli, Francesco; Fermi, Matteo; Ghirelli, Michael ...
European archives of oto-rhino-laryngology,
07/2020, Letnik:
277, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Purpose
The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients.
Methods
We describe our synergic ...experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV.
Results
No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection.
Conclusion
In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.
RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación ...mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.
Invasive mechanical ventilation (IMV) is a lifesaving strategy for critically ill patients with coronavirus disease 2019 (COVID-19). We aim to report the case series of critical patients receiving ...IMV in Wuhan and to discuss the timing of IMV in these patients.
Data of 657 patients admitted to emergency intensive care unit of Zhongnan Hospital and isolated isolation wards of Wuhan Union Hospital from January 1 to March 10, 2020, were retrospectively reviewed. All medical records of 40 COVID-19 patients who required IMV were collected at different time points, including baseline (at admission), before receiving IMV, and before death or hospital discharge.
Among 40 COVID-19 patients with IMV, 31 died, and 9 survived and was discharged. The median age was 70 years (interquartile range IQR, 62-76 years), and nonsurvivors were older than survivors. The median period from the noninvasive mechanic ventilation (NIV) or high-flow nasal cannula oxygen therapy (HFNC) to intubation was 7 hours (IQR, 2-42 hours) in IMV survivors and 54 hours (IQR, 28-143 hours) in IMV nonsurvivors. We observed that, when the time interval from NIV/HFNC to intubation was less than 50 hours (about 2 calendar days), together with Acute Physiology and Chronic Health Evaluation II (APACHE II) score of less than 10 or pneumonia severity index (PSI) score of less than 100, mortality can be reduced to 60% or less. Prolonged interval from NIV/HFNC to intubation and high levels of APACHE II and PSI before intubation were associated with higher mortality in critically ill patients. Multiple organ damage was common among these nonsurvivors in the course of treatment.
Early initial intubation after NIV/HFNC might have a beneficial effect in reducing mortality for critically ill patients meeting IMV indication. Considering APACHE II and PSI scores might help physicians in decision making about timing of intubation for curbing subsequent mortality.
Therapeutic, level V.
Highlights of the 55th SEPAR Congress Martínez Meñaca, Amaya; Barbero Herranz, Esther; Muñoz-Esquerre, Mariana ...
Open respiratory archives,
2023 Jan-Mar, Letnik:
5, Številka:
1
Journal Article
Recenzirano
The 55th SEPAR Congress was held in Pamplona from 2 to 4 of June 2022. Once again, it was the referral scientific meeting for specialists in pulmonology, thoracic surgery, nursing, physiotherapy, ...paediatric respiratory diseases and other disciplines involved in respiratory care. The Spanish Society of Pulmonology and Thoracic Surgery showed its national and international leadership in the management of respiratory diseases, which was reflected in a program with an excellent content and a high scientific level. In this review, we offer a summary of some notable aspects covered in six selected areas of interest: pulmonary vascular diseases, non-invasive mechanical ventilation and sleep disorders, asthma, chronic obstructive pulmonary disease (COPD), interstitial lung diseases (ILD), and interventional pulmonolgy and lung transplant.
Resumen: El 55.° Congreso SEPAR, celebrado en Pamplona del 2 al 4 de junio de 2022, volvió a ser, una vez más, la reunión científica de referencia para los especialistas en neumología, cirugía ...torácica, enfermería, fisioterapia, neumología pediátrica y otras disciplinas implicadas en los cuidados respiratorios. Nuestra sociedad demostró de nuevo en este congreso su liderazgo nacional e internacional en el manejo de la patología respiratoria, y así se reflejó en un programa de excelente contenido y alto nivel científico. En esta revisión ofrecemos un resumen de algunos de los aspectos más destacables tratados en seis áreas de interés seleccionadas: circulación pulmonar, ventilación mecánica no invasiva y sueño, asma, enfermedad pulmonar obstructiva crónica (EPOC), enfermedades pulmonares intersticiales difusas (EPID) y técnicas y trasplante. Abstract: The 55th SEPAR Congress was held in Pamplona from 2 to 4 of June 2022. Once again, it was the referral scientific meeting for specialists in pulmonology, thoracic surgery, nursing, physiotherapy, paediatric respiratory diseases and other disciplines involved in respiratory care. The Spanish Society of Pulmonology and Thoracic Surgery showed its national and international leadership in the management of respiratory diseases, which was reflected in a program with an excellent content and a high scientific level. In this review, we offer a summary of some notable aspects covered in six selected areas of interest: pulmonary vascular diseases, non-invasive mechanical ventilation and sleep disorders, asthma, chronic obstructive pulmonary disease (COPD), interstitial lung diseases (ILD), and interventional pulmonolgy and lung transplant.
Introduction
The systemic viral disease caused by the SARS-CoV-2 called coronavirus disease 2019 (COVID-19) continues to be a public health problem worldwide.
Objective
This study is aimed to ...evaluate the association and predictive value of indices of systemic inflammation with severity and non-survival of COVID-19 in Mexican patients.
Materials and Methods
A retrospective study was carried out on 807 subjects with a confirmed diagnosis of COVID-19. Clinical characteristics, acute respiratory distress syndrome (ARDS), severity according to PaO
2
/FiO
2
ratio, invasive mechanical ventilation (IMV), and non-survival outcome were considered to assess the predictive value and the association of 11 systemic inflammatory indices derived from hematological parameters analyzed at the hospital admission of patients. The receiver operating characteristics curve was applied to determine the thresholds for 11 biomarkers, and their prognostic values were assessed
via
the Kaplan-Meier method.
Results
26% of the studied subjects showed COVID-19 severe (PaO
2
/FiO
2
ratio ≤ 100), 82.4% required IMV, and 39.2% were non-survival. The indices NHL, NLR, RDW, dNLR, and SIRI displayed predictive values for severe COVID-19 and non-survival. NHL, SIRI, and NLR showed predictive value for IMV. The cut-off values for RDW (OR = 1.85,
p
< 0.001), NHL (OR = 1.67,
p
= 0.004) and NLR (OR = 1.56,
p
= 0.012) were mainly associated with severe COVID-19. NHL (OR = 3.07,
p
< 0.001), AISI (OR = 2.64,
p
< 0.001) and SIRI (OR = 2.51,
p
< 0.001) were associated with IMV support, while for non-survival the main indices associated were NHL (OR = 2.65,
p
< 0.001), NLR (OR = 2.26,
p
< 0.001), dNLR (OR = 1.92,
p
< 0.001), SIRI (OR = 1.67,
p
= 0.002) and SII (OR = 1.50,
p
= 0.010). The patients with an RDW, PLR, NLR, dNLR, MLR, SII, and NHL above the cut-off had a survival probability of COVID-19 50% lower, with an estimated mean survival time of 40 days.
Conclusion
The emergent systemic inflammation indices NHL, NLR, RDW, SII, and SIRI have a predictive power of severe COVID-19, IMV support, and low survival probability during hospitalization by COVID-19 in Mexican patients.
Objectives
The number of children on home mechanical ventilation (HMV) has increased. Understanding the reasons for nonscheduled hospital admissions during HMV is critical. This study aims to ...investigate the risk factors of first nonscheduled hospital admissions of pediatric patients on HMV.
Methods
A retrospective analysis of patients on HMV between May 1, 2014 and October 1, 2020 was performed. Patients' demographic characteristics, duration of the education of the primary caregiver; time of first nonscheduled visit; and type of HMV (noninvasive mechanical ventilation NIV or invasive mechanical ventilation IMV) were analyzed. The reasons for first nonscheduled hospital visits were categorized as respiratory problems and other reasons.
Results
Of 97 patients, 41 were female (42.3%), and 70 (72%) were on IMV. The median age was 23 months (IQR, 10–91). Twenty‐nine patients (30%), were admitted to hospital before scheduled visit with a mean duration of 18.1 ± 11.6 days; of them, 14 (48.2%) admitted because of respiratory problems. IMV increases the risk of first nonscheduled visit compared to NIV (OR, 16.3; 95% CI, 2.1–127.4; p = .008). If a caregiver spends less than 14 days in hospital for education, risk of nonscheduled visits increases (OR, 4.0; 95% CI, 1.5–11.2; p = .007).
Conclusion
A minimum 14 days seems to be necessary for education of the caregivers of the patients with HMV to reduce the number of nonscheduled visits, which is a burden for both patients and healthcare system.
El 55.° Congreso SEPAR, celebrado en Pamplona del 2 al 4 de junio de 2022, volvió a ser, una vez más, la reunión científica de referencia para los especialistas en neumología, cirugía torácica, ...enfermería, fisioterapia, neumología pediátrica y otras disciplinas implicadas en los cuidados respiratorios. Nuestra sociedad demostró de nuevo en este congreso su liderazgo nacional e internacional en el manejo de la patología respiratoria, y así se reflejó en un programa de excelente contenido y alto nivel científico. En esta revisión ofrecemos un resumen de algunos de los aspectos más destacables tratados en seis áreas de interés seleccionadas: circulación pulmonar, ventilación mecánica no invasiva y sueño, asma, enfermedad pulmonar obstructiva crónica (EPOC), enfermedades pulmonares intersticiales difusas (EPID) y técnicas y trasplante.
The 55th SEPAR Congress was held in Pamplona from 2 to 4 of June 2022. Once again, it was the referral scientific meeting for specialists in pulmonology, thoracic surgery, nursing, physiotherapy, paediatric respiratory diseases and other disciplines involved in respiratory care. The Spanish Society of Pulmonology and Thoracic Surgery showed its national and international leadership in the management of respiratory diseases, which was reflected in a program with an excellent content and a high scientific level. In this review, we offer a summary of some notable aspects covered in six selected areas of interest: pulmonary vascular diseases, non-invasive mechanical ventilation and sleep disorders, asthma, chronic obstructive pulmonary disease (COPD), interstitial lung diseases (ILD), and interventional pulmonolgy and lung transplant.
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