Subramaniam Ashwin, Haji Jumana Y, Kumar Prashant, Ramanathan Kollengode, Rajamani Arvind
Department of Intensive Care, Frankston Hospital, Frankston, VIC Monash University, VIC, Frankston, Australia.
Department of Anesthesia and Critical Care, Aster CMI Hospital, Bengaluru, Karnataka, India.
Indian J Crit Care Med. 2020 Oct;24(10):926-931. doi: 10.5005/jp-journals-10071-23640.
About 5% of hospitalized coronavirus disease 2019 (COVID-19) patients will need intensive care unit (ICU) admission for hypoxemic respiratory failure requiring oxygen support. The choice between early mechanical ventilation and noninvasive oxygen therapies, such as, high-flow nasal oxygen (HFNO) and/or noninvasive positive-pressure ventilation (NPPV) has to balance the contradictory priorities of protecting healthcare workers by minimizing aerosol-generation and optimizing resource management. This survey over two timeframes aimed to explore the controversial issue of location and noninvasive oxygen therapy in non-intubated ICU patients using a clinical vignette.
An online survey was designed, piloted, and distributed electronically to Indian intensivists/anesthetists, from private hospitals, government hospitals, and medical college hospitals (the latter two referred to as first-responder hospitals), who are directly responsible for admitting/managing patients in ICU.
Of the 204 responses (125/481 in phase 1 and 79/320 in phase 2), 183 responses were included. Respondents from first-responder hospitals were more willing to manage non-intubated hypoxemic patients in neutral pressure rooms, while respondents from private hospitals preferred negative-pressure rooms ( < 0.001). In both the phases, private hospital doctors were less comfortable to use any form of noninvasive oxygen therapies in neutral-pressure rooms compared to first-responder hospitals (low-flow oxygen therapy: 72 vs 50%, < 0.01; HFNO: 47 vs 24%, < 0.01 and NPPV: 38 vs 28%, = 0.20).
Variations existed in practices among first-responder and private intensivists/anesthetists. The resource optimal private hospital intensivists/anesthetists were less comfortable using noninvasive oxygen therapies in managing COVID-19 patients. This may reflect differential resource availability necessitating resolution at national, state, and local levels.
Subramaniam A, Haji JY, Kumar P, Ramanathan K, Rajamani A. Noninvasive Oxygen Strategies to Manage Confirmed COVID-19 Patients in Indian Intensive Care Units: A Survey. Indian J Crit Care Med 2020;24(10):926-931.
约5%的新型冠状病毒肺炎（COVID-19）住院患者因低氧性呼吸衰竭需要氧疗支持而需入住重症监护病房（ICU）。早期机械通气与无创氧疗（如高流量鼻导管给氧（HFNO）和/或无创正压通气（NPPV））之间的选择，必须在通过尽量减少气溶胶产生来保护医护人员和优化资源管理这两个相互矛盾的优先事项之间取得平衡。这项在两个时间段进行的调查旨在通过一个临床案例探讨非插管ICU患者的安置地点及无创氧疗这一有争议的问题。
设计了一项在线调查，进行预试验后，以电子方式分发给印度私立医院、政府医院和医学院附属医院（后两者称为一线医院）的重症医学专家/麻醉师，他们直接负责ICU患者的收治/管理。
在204份回复中（第一阶段125/481份，第二阶段79/320份），纳入了183份回复。一线医院的受访者更愿意在中性压力病房管理非插管低氧患者，而私立医院受访者更喜欢负压病房（<0.001）。在两个阶段中，与一线医院相比，私立医院医生在中性压力病房使用任何形式的无创氧疗时都不太自在（低流量氧疗：72%对50%，<0.01；HFNO：47%对24%，<0.01；NPPV：38%对28%，=0.20）。
一线医院和私立医院的重症医学专家/麻醉师在做法上存在差异。资源充足的私立医院重症医学专家/麻醉师在管理COVID-19患者时使用无创氧疗不太自在。这可能反映了不同的资源可用性，需要在国家、州和地方层面加以解决。
Subramaniam A, Haji JY, Kumar P, Ramanathan K, Rajamani A. 印度重症监护病房管理确诊COVID-19患者的无创氧疗策略：一项调查。《印度重症医学杂志》2020年；24(10):926 - 931。
