Compared to NIPPV, HFNC is more dangerous regarding aerosol dispersion and contamination of healthcare personnel: we are not sure

Honoré, Patrick M.; Gutierrez, Leonel Barreto; Kugener, Luc; Redant, Sébastien; Attou, Rachid; Gallerani, Andrea; Bels, David De

doi:10.1186/s13054-020-03184-y

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…To date, no studies related to COVID-19 have directly evidenced this risk. Furthermore, findings with regard to droplet dispersion and aerosol generation with HFNC are uncertain and the increased risks of aerosolization with NIPPV compared with HFNC are largely unknown ( 33 – 35 ).…”

Section: Discussionmentioning

confidence: 99%

Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

Dupuis

Bouadma

Montmollin

et al. 2021

Critical Care Explorations

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Objectives: About 5% of patients with coronavirus disease-2019 are admitted to the ICU for acute hypoxemic respiratory failure. Opinions differ on whether invasive mechanical ventilation should be used as first-line therapy over noninvasive oxygen support. The aim of the study was to assess the effect of early invasive mechanical ventilation in coronavirus disease-2019 with acute hypoxemic respiratory failure on day-60 mortality. Design: Multicenter prospective French observational study. Setting: Eleven ICUs of the French OutcomeRea network. Patients: Coronavirus disease-2019 patients with acute hypoxemic respiratory failure (Pao 2/Fio 2 ≤ 300 mm Hg), without shock or neurologic failure on ICU admission, and not referred from another ICU or intermediate care unit were included. Intervention: We compared day-60 mortality in patients who were on invasive mechanical ventilation within the first 2 calendar days of the ICU stay (early invasive mechanical ventilation group) and those who were not (nonearly invasive mechanical ventilation group). We used a Cox proportional-hazard model weighted by inverse probability of early invasive mechanical ventilation to determine the risk of death at day 60. Measurement and Main Results: The 245 patients included had a median (interquartile range) age of 61 years (52–69 yr), a Simplified Acute Physiology Score II score of 34 mm Hg (26–44 mm Hg), and a Pao 2/Fio 2 of 121 mm Hg (90–174 mm Hg). The rates of ICU-acquired pneumonia, bacteremia, and the ICU length of stay were significantly higher in the early (n = 117 [48%]) than in the nonearly invasive mechanical ventilation group (n = 128 [52%]), p < 0.01. Day-60 mortality was 42.7% and 21.9% in the early and nonearly invasive mechanical ventilation groups, respectively. The weighted model showed that early invasive mechanical ventilation increased the risk for day-60 mortality (weighted hazard ratio =1.74; 95% CI, 1.07–2.83, p=0.03). Conclusions: In ICU patients admitted with coronavirus disease-2019-induced acute hypoxemic respiratory failure, early invasive mechanical ventilation was associated with an increased risk of day-60 mortality. This result needs to be confirmed.

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Section: Discussionmentioning

confidence: 99%

Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

Dupuis

Bouadma

Montmollin

et al. 2021

Critical Care Explorations

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“…Patients admitted since July 25, 2020 received intravenous dexamethasone 6 mg per day for 10 days. In addition, preliminary data on risk contamination (viral aerosolization) leads to reassurance for non-invasive ventilatory assistance, such as HFNO and face-mask NIV [32][33][34]. At this time, we used HFNO as first line oxygen therapy for all patients admitted since July 25, 2020 for a de novo acute respiratory failure related to a proven SARS-CoV2 infection.…”

Section: Standardized Icu Management Of Patients With Covid-19-relate...mentioning

confidence: 99%

Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Ferré

Marquion

Delord

et al. 2022

Ann. Intensive Care

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Background To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. Results We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan–Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55–73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24–3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16–5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77–5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11–32] vs. 21 [13–37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14–40] vs. 27 [15–44] days, respectively; P = 0.44). Conclusions In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.

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“…Similarly, several other articles on oxygen therapy, high-flow nasal oxygenation, endotracheal intubation, mechanical ventilation, prone positioning, usage of corticosteroids, anti-bacterial, anti-viral drugs in COVID-19 patients, adoption of prophylactic measures like face masks and social distancing, COVID-19 vaccination during pregnancy and many more related issues got published during the initial days of the pandemic, which instead of providing valid evidence for the physicians to offer evidence-based patient care created doubts and dilemmas in their minds. [ 10 11 12 13 14 15 16 17 18 19 20 ]…”

Section: Challenges Faced By the Physician For The Practice Of Ebm Du...mentioning

confidence: 99%

Challenges for the practice of evidence-based medicine during COVID-19 pandemic (practice of evidence-based medicine in the new normal)

Kotur

2022

Indian Journal of Anaesthesia

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The forces which had kept the evidence-based medicine (EBM) movement alive and ongoing have altered significantly during this coronavirus disease (COVID)-19 pandemic. There has been discrepancy in the demand and availability of scientific evidence. Deaths of thousands of people including physicians and other health-care workers (while offering COVID-19 care) across the globe have shaken the confidence of the physicians towards the practice of EBM. Journals started publishing in a hurry, incomplete and at times misleading scientific articles, about COVID-19, leaving the physicians in a dilemma about the evidence. The practitioner of EBM has had to turn helplessly to non-documentary evidences to treat COVID-19 patients. Apart from the evidence becoming hyperdynamic and volatile along with a reduction in its quality, the environment got polluted by political interference. In a nutshell, the COVID-19 pandemic has affected the practice of EBM and its acceptance in multiple ways.

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Compared to NIPPV, HFNC is more dangerous regarding aerosol dispersion and contamination of healthcare personnel: we are not sure

Cited by 7 publications

References 8 publications

Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia

Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study

Challenges for the practice of evidence-based medicine during COVID-19 pandemic (practice of evidence-based medicine in the new normal)

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