Development of a work of breathing scale and monitoring need of intubation in COVID-19 pneumonia

Apigo, Mylene; Schechtman, Jeffrey; Dhliwayo, Nyembezi; Tameemi, Mohammed Al; Gazmuri, Raúl J.

doi:10.1186/s13054-020-03176-y

Cited by 48 publications

(37 citation statements)

References 6 publications

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“…The mortality of the patients undergoing subsequent intubation was similar to that of patients who were treated with mechanical ventilation at ICU admission: HR for IMV versus NIV failure, 1.20; 95% CI, 0.95–1.53; p = 0.12). Tools have been developed to avoid a deleterious delayed intubation in patients suffering from COVID-AHRF ( 45 , 46 ). In pneumonia patients with AHRF under HFNC, the ratio of oxygen saturation as measured by pulse oximetry/F io 2 to respiratory rate is an index that can help to identify those with low and those with high risk for intubation ( 47 ).…”

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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“…According to the necessity of intubation, specialists suggested the use of esophageal manometry (as a surrogate of pleural pressure) and considering intubation when pressure swings exceed 15 cm H2O indicating the risk of self-inflicted lung injury (54). Based on experience-based recommendations, once the patient's noninvasive ventilation failed, elective intubation should be preferred to minimize clinical risks, such as contamination of medical staff (55).…”

Section: Discussionmentioning

confidence: 99%

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

2021

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Background: Severe coronavirus disease 2019 (COVID-19) can induce acute respiratory distress, which is characterized by tachypnea, hypoxia, and dyspnea. Intubation and mechanical ventilation are strategic treatments for COVID-19 distress or hypoxia. Methods: We searched PubMed, Embase, and Scopus databases to identify relevant randomized control trials, observational studies, and case series published from April 1, 2021. Results: 24 studies were included in this review. Studies had been conducted in the USA, China, Spain, South Korea, Italy, Iran, and Brazil. Most patients had been intubated in the intensive care unit. Rapid sequence induction had been mostly used for intubation. ROX index can be utilized as the predictor of the necessity of intubation in COVID-19 patients. According to the studies, the rate of intubation was 5 to 88%. It was revealed that 1.4 - 44.5% of patients might be extubated. Yet obesity and age (elderly) are the only risk factors of delayed or difficult extubation. Discussion and Conclusions: Acute respiratory distress in COVID-19 patients could require endotracheal intubation and mechanical ventilation. Severe respiratory distress, loss of consciousness, and hypoxia had been the most important reasons for intubation. Also, increased levels of C-reactive protein (CRP), ferritin, d-dimer, and lipase in combination with hypoxia are correlated with intubation. Old age, diabetes mellitus, respiratory rate, increased level of CRP, bicarbonate level, and oxygen saturation are the most valuable predictors of the need for mechanical ventilation. ICU admission mortality following intubation was found to be 15 to 36%. Awake-prone positioning in comparison with high-flow nasal oxygen therapy did not reduce the risk of intubation and mechanical ventilation. There was no association between intubation timing and mortality of the infected patients. Noninvasive ventilation may have survival benefits.

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“…This scale includes respiratory rate, nasal flaring on inspiration, sternocleidomastoid use, and abdominal muscle use for a maximum of 7 points; intubation is proposed if the total score exceeds 4. 124 Figure 4 shows a possible strategy to recognize patients at risk of non-invasive respiratory support failure. The degree of lung impairment and patients’ comorbidities remain key factors to understand which device and respiratory support could be more suitable for each patient to avoid intubation and mechanical ventilation and prevent P-SILI.…”

Section: How Can P-sili Be Prevented?mentioning

confidence: 99%

Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review

Battaglini

Robba

Ball

et al. 2021

British Journal of Anaesthesia

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Coronavirus disease 2019 (COVID-19) pneumonia is associated with hypoxemic respiratory failure, ranging from mild to severe. Due to the worldwide shortage of intensive care unit beds, a relatively high number of patients with respiratory failure are receiving prolonged non-invasive respiratory support, even when their clinical status would have required invasive mechanical ventilation. There are few experimental and clinical data reporting that vigorous breathing effort during spontaneous ventilation can worsen lung injury and cause a phenomenon that has been termed patient self-inflicted lung injury (P-SILI). The aim of this narrative review is to provide an overview of P-SILI pathophysiology and the role of non-invasive respiratory support in COVID-19 pneumonia. Respiratory mechanics, vascular compromise, viscoelastic properties, lung inhomogeneity, work of breathing, and oesophageal pressure swings are discussed. The concept of P-SILI has been widely investigated in recent years, but controversies persist regarding its mechanisms. To minimize the risk of P-SILI, intensivists should better understand its underlying pathophysiology to optimize the type of non-invasive respiratory support provided to patients with COVID-19 pneumonia, as well as decide on the optimal timing of intubation for these patients.

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Development of a work of breathing scale and monitoring need of intubation in COVID-19 pneumonia

Cited by 48 publications

References 6 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

Invasive Airway "Intubation" in COVID-19 Patients; Statistics, Causes, and Recommendations: A Review Article

Noninvasive respiratory support and patient self-inflicted lung injury in COVID-19: a narrative review

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