ABSTRACT
BACKGROUND: Noninvasive ventilation (NIV) and High-flow nasal cannula (HFNC) are the main forms of treatment for acute respiratory failure. This study aimed to evaluate the effect, safety, and applicability of the NIV and HFNC in patients with acute hypoxemic respiratory failure (AHRF) caused by COVID-19. METHODS: In this retrospective study, we monitored the effect of NIV and HFNC on the SpO2 and respiratory rate before, during, and after treatment, length of stay, rates of endotracheal intubation, and mortality in patients with AHRF caused by COVID-19. Additionally, data regarding RT-PCR from physiotherapists who were directly involved in assisting COVID-19 patients and non-COVID-19. RESULTS: 62.2 % of patients were treated with HFNC. ROX index increased during and after NIV and HFNC treatment (P < 0.05). SpO2 increased during NIV treatment (P < 0.05), but was not maintained after treatment (P = 0.17). In addition, there was no difference in the respiratory rate during or after the NIV (P = 0.95) or HFNC (P = 0.60) treatment. The mortality rate was 35.7 % for NIV vs 21.4 % for HFNC (P = 0.45), while the total endotracheal intubation rate was 57.1 % for NIV vs 69.6 % for HFNC (P = 0.49). Two adverse events occurred during treatment with NIV and eight occurred during treatment with HFNC. There was no difference in the physiotherapists who tested positive for SARS-COV-2 directly involved in assisting COVID-19 patients and non-COVID-19 ones (P = 0.81). CONCLUSION: The application of NIV and HFNC in the critical care unit is feasible and associated with favorable outcomes. In addition, there was no increase in the infection of physiotherapists with SARS-CoV-2.
Subject(s)
COVID-19/therapy , Cannula , Intubation, Intratracheal , Noninvasive Ventilation , Outcome and Process Assessment, Health Care , Oxygen/administration & dosage , Positive-Pressure Respiration , Respiratory Insufficiency/therapy , Respiratory Rate/drug effects , Acute Disease , Administration, Inhalation , Adult , Aged , Aged, 80 and over , Brazil , COVID-19/complications , COVID-19/mortality , Cannula/adverse effects , Cannula/standards , Cannula/statistics & numerical data , Feasibility Studies , Female , Humans , Intensive Care Units , Intubation, Intratracheal/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Noninvasive Ventilation/adverse effects , Noninvasive Ventilation/methods , Noninvasive Ventilation/standards , Noninvasive Ventilation/statistics & numerical data , Outcome and Process Assessment, Health Care/statistics & numerical data , Physical Therapists , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/standards , Positive-Pressure Respiration/statistics & numerical data , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Retrospective StudiesABSTRACT
Uma paciente em crise aguda de asma, refratária ao uso de beta2-agonista inalatório e intravenoso, aminofilina intravenosa e corticóide, em ventilação mecânica, foi tratada com métodos terapêuticos não convencionais: broncoscopia, lavado broncoalveolar com N-acetilcisteína e ventilação com halotano. Houve melhora dos parâmetros ventilatórios após o lavado e a resolução do broncoespasmo ocorreu após a anestesia, propiciando a extubação e alta da UTI. É feita uma revisão da literatura sobre o uso desses métodos na crise aguda de asma