Medical staff caring for COVID-

Background The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19-related hypoxaemic respiratory failure (HRF), particularly in s``ettings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied. Methods We included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO. Findings The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (P a O2/FiO 2 ) was 68 (54–92) in 293 enroled patients. Of these, 137/293 (47%) of patients [P a O2/FiO 2 76 (63–93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3–9) in those successfully treated versus 2 (1–5) days in those who failed ( p <0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31–0.60), as was use of steroids (AHR 0.35, 95%CI 0.19–0.64). A ROX-6 score of ≥3.7 was 80% predictive of successful weaning whilst ROX-6 ≤ 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%). Interpretation In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation.

Low-and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs) including asthma, chronic obstructive pulmonary disease, bronchiectasis and post-tuberculous lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases, and contribute to complex multi-morbidity, with significant consequences for the lives and livelihoods of those affected.The relevance of CRDs to health and socioeconomic wellbeing is expected to increase over time, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of CRDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals.In this review we focus on CRDs in low-and middle-income settings (LMICs). We discuss the early life origins of CRDs, challenges in prevention, diagnosis and management in LMICs, and pathways to solutions to achieve true Universal Health Coverage.