Role of Advanced Respiratory Support in Acute Respiratory Failure in Clinically Frail Patients with COVID-19

Abstract

Background: The main aim of this study was to assess the efficacy of advanced respiratory support (ARS) for acute respiratory failure in do-not-attempt cardiopulmonary resuscitation order (DNACPR) COVID-19 patients. Methods: In this single-center study, the impact of different types of ARS modality, PaO2/FiO2 (PF) ratio, clinical frailty score (CFS) and 4C score on mortality was evaluated. Results: There was no significant difference in age, type of ARS modality, PF ratio and 4C scores between those who died and those who survived. Overall survival rates/hospital discharge of patients still requiring ARS at 5 and 7 days post admission were 20 and 17%, respectively. Conclusion: Our study showed that ARS can be a useful tool in frail, elderly and high-risk COVID-19 patients irrespective of high 4C mortality score.

Comparison between high-flow nasal cannula and noninvasive ventilation in COVID-19 patients: a systematic review and meta-analysis

“…After excluding duplicates and evaluating the full texts of articles, we identified 23 eligible studies 9 , 11 – 32 (3 RCTs, 20 , 24 , 26 8 prospective observational studies, 13 , 16 , 18 , 19 , 22 , 25 , 28 , 30 and 12 retrospective observational studies). 9 , 11 , 12 , 14 , 15 , 17 , 21 , 23 , 27 , 29 , 31 , 32 The process of searching and screening is described in Figure 1 . The main characteristics of the articles included in the meta-analysis are shown in Table 1 .…”

“…Two studies were considered to have an unclear risk of bias. The 20 observational 9 , 11 – 19 , 21 – 23 , 25 , 27 – 32 studies were assessed using the NOS checklist, and the results are shown in the Table 2 . All studies were of medium quality (⩾5 stars) or above, and 10 were considered high quality (⩾8 stars).…”

“…A total of 5354 patients participated in the 23 studies 9 , 11 – 32 of the present meta-analysis, all of whom were adult COVID-19 patients. The patients were admitted to different hospital settings and received noninvasive respiratory support at the time of admission.…”

“…The patients were admitted to different hospital settings and received noninvasive respiratory support at the time of admission. In 4 studies, 11 , 17 , 20 , 25 a helmet was applied, in 11 studies, 9 , 13 – 15 , 18 , 19 , 26 , 28 , 29 , 30 , 32 a face mask was used, 1 study 22 reported applying both a helmet and a face mask, 7 studies 12 , 16 , 21 , 23 , 24 , 27 , 31 did not report whether a helmet or a facemask was used, in 6 studies, 9 , 20 , 22 , 24 , 27 , 29 BiPAP was applied, 7 studies 11 , 17 – 19 , 25 , 26 , 30 featured CPAP, 4 studies 14 – 16 , 23 reported applying both BiPAP and CPAP, and 6 studies 12 , 13 , 21 , 28 , 31 , 32 did not report whether they applied BiPAP or CPAP ( Table 1…”

“…A total of 5196 patients participated in 20 studies 9 , 12 – 20 , 23 – 32 that reported mortality, and the pooled estimates demonstrated that mortality rate was lower in HFNC groups than in NIV groups [OR = 0.66, 95% CI: 0.51–0.84, p = 0.0008, I 2 = 60%, Figure 4(a) ]. However, in subgroup analysis, no significant differences in mortality were observed in the HFNC group relative to NIV-helmet group [OR = 1.21, 95% CI: 0.63–2.32, p = 0.57, I 2 = 0%, Figure 5(a) ] or the NIV-CPAP group [OR = 0.77, 95% CI: 0.51–1.17, p = 0.23, I 2 = 65%, Figure 5(b) ], but significant differences in mortality were observed in the HFNC group relative to the NIV-facemask group [OR = 0.58, 95% CI: 0.41–0.81, p = 0.001, I 2 = 63%, Figure 5(a) ] or the NIV-BiPAP group [OR = 0.60, 95% CI: 0.45–0.79, p = 0.0003, I 2 = 5%, Figure 5(b) ].…”