RÉSUMÉ
INTRODUCTION: The availability of high-flow oxygen (HFO) machines allowed patients with COVID-19 pneumonia to be comfortably treated for longer periods of time until endotracheal intubation became inevitable. Patients treated with invasive mechanical ventilation (MV) preceded by HFO treatment may continue to progress and die. Hence there is a belief in physicians that patients treated with HFO might have delayed invasive MV. METHODS: The study was conducted as a retrospective review of subjects with confirmed COVID-19 admitted to the Dubai Hospital ICU. Study variables included time to intubation, duration of HFO, and cumulative duration of tachypnea and tachycardia while on HFO usage. Early intubation was defined as within 24 hours of the start of HFO, and late intubation was defined as after seven days on HFO. Groups were compared for outcome measures; mortality and length of stay (LOS) in the ICU and hospital. RESULTS: Clinical outcomes of mortality and LOS in ICU and hospital were not significantly different among patients intubated early versus late. Duration of tachypnea and tachycardia was also not different comparing patients intubated early versus late. CONCLUSION: There was no significant difference in clinical outcomes in patients intubated early versus late in patients treated with HFO for COVID-19 pneumonia.
RÉSUMÉ
BACKGROUND: Low tidal volume ventilation (LTVV) strategy improves outcomes; however, despite recommended by guidelines, adherence to this practice is not high. METHODS: Tidal volume for mechanically ventilated patients were recorded for each 12-hour shift, day and night shifts for consecutive 101 patients. Adherence was determined by comparing these tidal volumes to standard low tidal volumes of 6 ml/kg of ideal body weight. Adherence rates were calculated and adherence rates of daytime shifts were compared to those of night time shifts. Adherence rates for weekday shifts were compared with those of weekend shifts. Clinical variables were recorded to analyze predictors of adherence pattern. RESULTS: The sample size was 101 patients with 870 patient-ventilator days with 1734 patient ventilator shifts. Shift adherence was only 47.5%. There was no significant difference between day and night shifts or weekday and weekend shifts. Stepwise multiple regression analysis shows that age, gender, body mass index (BMI), and partial pressure of carbon dioxide (PCO2) have significant correlation with adherence to LTVV practice. CONCLUSION: The study found that adherence to lung protective low tidal volume mechanical ventilation practice is low. Practice adherence is not different over weekend or night shifts. Age, gender, BMI, and PCO2 have significant correlation with adherence to LTVV practice.
