Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients...Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.展开更多
BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD...BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.展开更多
Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that b...Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.展开更多
Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical vent...Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.展开更多
Background:Surfactant replacement therapy has been used for few decades for the treatment of respiratory distress syndrome(RDS)and has significantly improved morbidity and mortality in premature infants.Non-invasive r...Background:Surfactant replacement therapy has been used for few decades for the treatment of respiratory distress syndrome(RDS)and has significantly improved morbidity and mortality in premature infants.Non-invasive respiratory support has recently emerged as a strategy in the early management of RDS.In this review,we discuss the different strategies of early management of RDS.Data sources:A literature search of PubMed database was conducted to review the subject.The quality of evidence of key clinical studies was graded according to a modified grading system of the international GRADE group.Results:Continuous positive airway pressure(CPAP)with selective surfactant is a safe alternative to routine intubation,surfactant and mechanical ventilation in preterm infants with spontaneous breathing,and such an approach has been associated with decreased risk of death and bronchopulmonary dysplasia.There is a risk of pneumothorax when using a high pressure of CPAP(≥8 cm of H_(2)O),a high partial pressure of carbon dioxide(PCO_(2)>75 mm of Hg),and a high fraction of inspired oxygen(FiO_(2)>0.6)as a threshold for intubation while on CPAP.Conclusion:Not all preterm infants need surfactant treatment,and non-invasive respiratory support is a safe and effective approach.展开更多
文摘Objective:To evaluate the in-hospital outcome of moderate to severe COVID-19 patients admitted in High Dependency Unit(HDU)in relation to invasive vs.non-invasive mode of ventilation.Methods:In this study,the patients required either non-invasive[oxygen≤10 L/min or>10 L/min through mask or nasal prongs,rebreather masks and bilevel positive airway pressure(BiPAP)]or invasive ventilation.For analysis of 30-day in hospital mortality in relation to use of different modes of oxygen,Kaplan Meier and log rank analyses were used.In the end,independent predictors of survival were determined by Cox regression analysis.Results:Invasive ventilation was required by 15.1%patients while 84.9%patients needed non-invasive ventilation.Patients with evidence of thromboembolism,high inflammatory markers and hypoxemia mainly required invasive ventilation.The 30-day in hospital mortality was 72.7%for the invasive group and 12.9%for the non-invasive group(1.8%oxygen<10 L/min,0.9%oxygen>10 L/min,3.6%rebreather mask and 4.5%BiPAP).The median time from hospital admission to outcome was 7 days for the invasive group and 18 days for the non-invasive group(P<0.05).Age,presence of co-morbidities,number of days requiring oxygen,rebreather,BiPAP and invasive ventilation were independent predictors of outcome.Conclusions:Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator associated lung injury.Thus,protective non-invasive ventilation remains the necessary and safe treatment for severely hypoxic COVID-19 patients.
文摘BACKGROUND Studies have shown elevated C-reactive protein(CRP)to predict mechanical ventilation(MV)in patients with coronavirus disease 2019(COVID-19).Its utility is unknown in patients with chronic kidney disease(CKD),who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.AIM To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stagesⅢb-ⅤCKD and COVID-19.METHODS We conducted a retrospective cohort study on patients with COVID-19 and stagesⅢb-ⅤCKD.The primary outcome was the rate of invasive MV,the rate of noninvasive MV,and the rate of no MV.Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables.Cutoffs for variables were CRP:100 mg/L,ferritin:530 ng/mL,D-dimer:0.5 mg/L,and lactate dehydrogenase(LDH):590 U/L.RESULTS 290 were screened,and 118 met the inclusion criteria.CRP,D-dimer,and ferritin were significantly different among the three groups.On univariate analysis for invasive MV(IMV),CRP had an odds ratio(OR)-5.44;ferritin,OR-2.8;LDH,OR-7.7;D-dimer,OR-3.9,(P<0.05).The admission CRP level had an area under curve-receiver operator characteristic(AUROC):0.747 for the IMV group(sensitivity-80.8%,specificity-50%)and 0.663 for the non-IMV(NIMV)group(area under the curve,sensitivity-69.2%,specificity-53%).CONCLUSION Our results demonstrate a positive correlation between CRP,ferritin,and D-dimer levels and MV and NIMV rates in CKD patients.The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stagesⅢb-ⅤCKD.This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.
文摘Recently,there has been growing interest in knowing the best hygrometry level during high-flow nasal oxygen and non-invasive ventilation(NIV)and its potential influence on the outcome.Various studies have shown that breathing cold and dry air results in excessive water loss by nasal mucosa,reduced mucociliary clearance,in-creased airway resistance,reduced epithelial cell function,increased inflammation,sloughing of tracheal epithe-lium,and submucosal inflammation.With the Coronavirus Disease 2019 pandemic,using high-flow nasal oxygen with a heated humidifier has become an emerging form of non-invasive support among clinicians.However,we cannot always assume stable humidification.Similarly,there are no clear guidelines for using humidification dur-ing NIV,although humidification of inspired gas during invasive ventilation is an accepted standard of care.NIV disturbs the normal physiological system that warms and humidifies inspired gases.If NIV is supplied through an intensive care unit ventilator that utilizes anhydrous gases from compressed wall air and oxygen,the risk of dry-ness increases.In addition,patients with acute respiratory failure tend to breathe through the mouth during NIV,which is a less efficient route than nasal breathing for adding heat and moisture to the inspired gas.Obstructive sleep apnea syndrome is one of the most important indications for chronic use of NIV at home.Available data suggest that up to 60%of patients with obstructive sleep apnea syndrome who use continuous positive airway pressure therapy experience nasal congestion and dryness of the mouth and nose.Therefore,humidifying the inspired gas in NIV may be essential for patient comfort and compliance with treatment.We aimed to review the available bench and clinical studies that addressed the utility of hygrometry in NIV and nasal high-flow oxygen and discuss the technical limitations of different humidification systems for both systems.
基金The authors wish to acknowledge the funding support for the HASARS Database on data collection and management from the Hong Kong Government’s Health,Welfare and Food Bureau and Research Fund for the Control of lnfectious Diseases.
文摘Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality.
文摘Background:Surfactant replacement therapy has been used for few decades for the treatment of respiratory distress syndrome(RDS)and has significantly improved morbidity and mortality in premature infants.Non-invasive respiratory support has recently emerged as a strategy in the early management of RDS.In this review,we discuss the different strategies of early management of RDS.Data sources:A literature search of PubMed database was conducted to review the subject.The quality of evidence of key clinical studies was graded according to a modified grading system of the international GRADE group.Results:Continuous positive airway pressure(CPAP)with selective surfactant is a safe alternative to routine intubation,surfactant and mechanical ventilation in preterm infants with spontaneous breathing,and such an approach has been associated with decreased risk of death and bronchopulmonary dysplasia.There is a risk of pneumothorax when using a high pressure of CPAP(≥8 cm of H_(2)O),a high partial pressure of carbon dioxide(PCO_(2)>75 mm of Hg),and a high fraction of inspired oxygen(FiO_(2)>0.6)as a threshold for intubation while on CPAP.Conclusion:Not all preterm infants need surfactant treatment,and non-invasive respiratory support is a safe and effective approach.
