Does the use of a diving mask adapted for non-invasive ventilation in hypoxemic acute respiratory failure in individuals with and without COVID-19 increase the ratio of arterial oxygen partial pressure to fractional inspired oxygen? A randomized clinical trial.

Non-invasive ventilation (NIV) can be used in acute hypoxemic respiratory failure (AHRF); however, verifying the best interface for its use needs to be evaluated in the COVID-19 pandemic scenario. The objective of this study was to evaluate the behavior of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio) in patients with AHRF with and without COVID-19 undergoing NIV with the conventional orofacial mask and the adapted diving mask. This is a randomized clinical trial in which patients were allocated into four groups: i) group 1: COVID-19 + adapted mask (n=12); ii) group 2: COVID-19 + conventional orofacial mask (n=12); iii) group 3: non-COVID-19 + adapted mask (n=2); iv) group 4: non-COVID-19 + conventional orofacial mask (n=12). The PaO2/FiO2 ratio was obtained 1, 24, and 48 hours after starting NIV, and the success of NIV was evaluated. This study followed the norms of the Consolidated Standards of Reporting Trials statement and was registered in the Brazilian Registry of Clinical Trials under registration RBR-7xmbgsz. Both the adapted diving mask and the conventional orofacial mask increased the PaO2/FiO2 ratio. The interfaces differed in terms of the PaO2/FiO2 ratio in the first hour [309.66 (11.48) and 275.71 (11.48), respectively] (p=0.042) and 48 hours [365.81 (16.85) and 308.79 (18.86), respectively] (p=0.021). NIV success was 91.7% in groups 1, 2, and 3, and 83.3% in group 4. No adverse effects related to interfaces or NIV were observed. NIV through the conventional orofacial mask interfaces and the adapted diving mask was effective in improving the PaO2/FiO2 ratio; however, the adapted mask presented a better PaO2/FiO2 ratio during use. There was no significant difference between interfaces regarding NIV failure.

Prioritization to ensure care in COVID-19 pandemic / Priorização para garantir cuidado na pandemia COVID-19

Abstract Objectives: to develop a flow to ensure care for all people with severe acute respiratory syndrome Coronavirus 2, offering from intensive care to palliative care, in an equitable and fair manner. Methods: the modified Delphi methodology was used to reach consensus on a flow and a prioritization index among specialists, the regional council of medicine, members of the healthcare system and the local judicial sector. Results: the score was incorporated into the flow as the final phase for building the list of patients who will be referred to intensive care, whenever a ventilator is available. Patients with lower scores should have priority access to the ICU. Patients with higher scores should receive palliative care associated with available curative measures. However, curative measures must be proportionate to the severity of the overall clinical situation and the prognosis. Conclusions: this tool could and will prevent patients from being excluded from access to the necessary health care so that their demands are assessed, their suffering is reduced, and their illnesses are cured, when possible.

Resumo Objetivos: desenvolver um fluxo para garantir o atendimento a todas as pessoas com Síndrome da Angústia Respiratória Aguda de forma equitativa e justa. Métodos: a metodologia Delphi modificada foi utilizada para obter um consenso sobre um fluxo e um escore de priorização entre especialistas do Conselho Regional de Medicina, membros gestores do sistema de saúde e setor judiciário local. Resultados: a priorização foi baseada na insuficiência aguda de órgãos, comorbidades, fragilidade e funcionalidade. O escore foi incorporado ao fluxo como fase final para construção da lista ordenada de pacientes que serão encaminhados para terapia intensiva, sempre que houver ventilador disponível. Pacientes com pontuações mais baixas devem ter prioridade de acesso à UTI. Pacientes com pontuações mais altas devem receber cuidados paliativos associados às medidas curativas disponíveis. No entanto, medidas curativas devem ser proporcionais à gravidade da situação clínica global e ao prognóstico. Conclusão: esta ferramenta pôde e poderá evitar que pacientes sejam excluídos do acesso aos cuidados de saúde necessários para que suas demandas sejam avaliadas, seu sofrimento diminuído e suas doenças curadas, quando possível.