Noninvasive Respiratory Strategies and Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19—Reply

Couper, Keith; Connolly, Bronwen; McAuley, Daniel F.

doi:10.1001/jama.2022.5279

Cited by 45 publications

(60 citation statements)

References 6 publications

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“…17 This study demonstrated a reduction in the primary composite outcome of tracheal intubation or mortality in the CPAP group compared to the group receiving standard oxygen therapy. 17 The statistical difference was driven by a reduction in tracheal intubation within 30 days, and no significant difference in mortality was demonstrated. 17 The RCU at the Royal Melbourne Hospital (RMH) is a permanent component of the Respiratory Medicine and Sleep Disorders service.…”

Section: Introductionmentioning

confidence: 65%

“…17 The statistical difference was driven by a reduction in tracheal intubation within 30 days, and no significant difference in mortality was demonstrated. 17 The RCU at the Royal Melbourne Hospital (RMH) is a permanent component of the Respiratory Medicine and Sleep Disorders service. It is a four-bed ward-annex for patients requiring specialist nursing and medical care, most commonly NIV, with a 2:1 nursing ratio.…”

Section: Introductionmentioning

confidence: 96%

“…RECOVERY‐RS examined patients determined suitable for escalation to invasive ventilation and randomised them into three arms: CPAP, HFNP and ward‐based oxygen therapy 17 . This study demonstrated a reduction in the primary composite outcome of tracheal intubation or mortality in the CPAP group compared to the group receiving standard oxygen therapy 17 . The statistical difference was driven by a reduction in tracheal intubation within 30 days, and no significant difference in mortality was demonstrated 17 …”

Section: Introductionmentioning

confidence: 97%

“…The largest prospective study in this area to date is the RECOVERY‐RS trial, a multicentre, randomised control trial comparing oxygen delivery modalities in patients with hypoxaemic respiratory failure secondary to COVID‐19 17 . RECOVERY‐RS examined patients determined suitable for escalation to invasive ventilation and randomised them into three arms: CPAP, HFNP and ward‐based oxygen therapy 17 . This study demonstrated a reduction in the primary composite outcome of tracheal intubation or mortality in the CPAP group compared to the group receiving standard oxygen therapy 17 .…”

Section: Introductionmentioning

confidence: 99%

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An Australian COVID‐19 respiratory care unit experience

Ward‐Ambler

Wallbridge

Singh

et al. 2023

Internal Medicine Journal

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Background: Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a heterogeneous presentation ranging from severe pneumonitis to asymptomatic infection. International studies have demonstrated the utility of respiratory care units (RCUs) to facilitate the delivery of non-invasive ventilation techniques to patients with COVID-19 pneumonitis.Aims: This study aims to describe the patient characteristics, flow and outcomes of admissions to the Royal Melbourne Hospital (RMH) COVID-19 RCU (CRCU) during its initial period of operation.Methods: Single-centre retrospective cohort study, all patients admitted to CRCU between 17 September and 10 December 2021 were included in this study. Patient demographics, including comorbidities and limitations of medical treatment, were analysed. Admission source and discharge destination were reviewed. Length of stay was recorded. Finally, in-hospital and CRCU mortality were analysed.Results: Ninety-seven patients, comprising 111 admissions, occurred during the study period with median age of 65 years (48% female). Most patients were admitted from and discharged to the ward. Twenty patients died in hospital (21%), with age, 4C score, comorbidity and presence of obstructive lung disease predicting mortality (area under the curve (AUC) 0.85, P < 0.001). Mortality was significantly higher in those over 65 years of age compared to those under 65 (P < 0.001), or those deemed not for intubation compared to those for intubation (P = 0.0019).Conclusions: This study demonstrates the feasibility of operating a CRCU within an Australian tertiary healthcare setting.

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Section: Introductionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

An Australian COVID‐19 respiratory care unit experience

Ward‐Ambler

Wallbridge

Singh

et al. 2023

Internal Medicine Journal

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“…However, not all patients can tolerate NIV owing to adverse events, such as claustrophobia, facial pressure ulcers and eye irritation 44 45. In an RCT that included 1273 patients, the authors compared the effects of HFNC, COT and continuous positive airway pressure (CPAP) on the 30-day intubation rate and 30-day mortality in patients with COVID-19-related AHRF 46. The results showed a significant decrease in intubation rate in the CPAP group compared with that in the COT group, but there was no significant difference in mortality.…”

Section: Discussionmentioning

confidence: 99%

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review

Chang

et al. 2023

BMJ Open

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ObjectiveThis study aimed to investigate the effect of high-flow nasal cannula therapy (HFNC) versus conventional oxygen therapy (COT) on intubation rate, 28-day intensive care unit (ICU) mortality, 28-day ventilator-free days (VFDs) and ICU length of stay (ICU LOS) in adult patients with acute respiratory failure (ARF) associated with COVID-19.DesignSystematic review and meta-analysis.Data sourcesPubMed, Web of Science, Cochrane Library and Embase up to June 2022.Eligibility criteria for selecting studiesOnly randomised controlled trials or cohort studies comparing HFNC with COT in patients with COVID-19 were included up to June 2022. Studies conducted on children or pregnant women, and those not published in English were excluded.Data extraction and synthesisTwo reviewers independently screened the titles, abstracts and full texts. Relevant information was extracted and curated in the tables. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to assess the quality of randomised controlled trials or cohort studies. Meta-analysis was conducted using RevMan V.5.4 computer software using a random effects model with a 95% CI. Heterogeneity was assessed using Cochran’s Q test (χ2) and Higgins I2statistics, with subgroup analyses to account for sources of heterogeneity.ResultsNine studies involving 3370 (1480 received HFNC) were included. HFNC reduced the intubation rate compared with COT (OR 0.44, 95% CI 0.28 to 0.71, p=0.0007), decreased 28-day ICU mortality (OR 0.54, 95% CI 0.30 to 0.97, p=0.04) and improved 28-day VFDs (mean difference (MD) 2.58, 95% CI 1.70 to 3.45, p<0.00001). However, HFNC had no effect on ICU LOS versus COT (MD 0.52, 95% CI −1.01 to 2.06, p=0.50).ConclusionsOur study indicates that HFNC may reduce intubation rate and 28-day ICU mortality, and improve 28-day VFDs in patients with ARF due to COVID-19 compared with COT. Large-scale randomised controlled trials are necessary to validate our findings.PROSPERO registration numberCRD42022345713.

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Effect of ventilation modalities on the early prognosis of patients with poststroke sleep apnea

Li,

Pang,

Zhang

et al. 2023

Ann Clin Transl Neurol

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ObjectiveContinuous positive airway pressure (CPAP) is the primary modality for treating sleep apnea after acute ischemic stroke (AIS). However, not all patients are well adherent to CPAP. Finding an alternative modality of ventilation to CPAP is essential.MethodsThis prospective randomized clinical trial was conducted from 1 May 2022 to 8 January 2023 at the Department of Neurology, Wuhan Union Hospital. Participants diagnosed with sleep apnea after AIS were grouped according to block randomization principles into the usual care group (nasal cannula and facemask), nasal continuous positive airway pressure (nCPAP) group, and high‐flow nasal cannula (HFNC) group. Rates of pulmonary infection and endotracheal intubation within 1 week of hospitalization and 28‐day mortality (poststroke) were the primary outcomes (early prognosis).ResultsIn the trial, 178 patients (119 males [66.85%]; mean [SD] age, 61.04 [11.78] years) were eventually enrolled in the usual care group (n = 63), the nCPAP group (n = 55), and the HFNC group (n = 60). After ventilation, the nCPAP and HFNC groups were more effective than the usual care group in reducing the rate of pulmonary infection, endotracheal intubation, and improving neurological function and sleep apnea severity. However, there was no difference in 28‐day mortality. Additionally, the improvement in prognosis was consistent between nCPAP and HFNC. In the comparison of comfort, the HFNC group was superior to nCPAP.InterpretationnCPAP and HFNC reduced early pulmonary infection rates and endotracheal intubation rates. For patients with poor compliance with nCPAP, HFNC may be the best alternative.

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Noninvasive Respiratory Strategies and Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure Due to COVID-19—Reply

Cited by 45 publications

References 6 publications

An Australian COVID‐19 respiratory care unit experience

An Australian COVID‐19 respiratory care unit experience

High-flow nasal cannula reduces intubation rate in patients with COVID-19 with acute respiratory failure: a meta-analysis and systematic review

Effect of ventilation modalities on the early prognosis of patients with poststroke sleep apnea

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