Isaac Barney Thomas Jesudason, Priya Nadesan, Nair Avinash Anil, Thangakunam Balamugesh, Balachandran Amith, George Tina, Thomas Sheba Meriam, George Tarun Kottukulam, Iyadurai Ramya, Kumar Selwyn Selva, Zachariah Anand, Singh Bhagteshwar, Rupali Priscilla, Pichamuthu Kishore, Gupta Richa, Daniel Jefferson, Sasikumar Jebin Roger, Chandy Sujith Thomas, Christopher Devasahayam Jesudas
Department of Pulmonary Medicine, Christian Medical College, Vellore, India.
Department of Respiratory Medicine, Christian Medical College, Vellore, India.
Mayo Clin Proc Innov Qual Outcomes. 2022 Jun;6(3):239-249. doi: 10.1016/j.mayocpiqo.2022.04.001. Epub 2022 Apr 19.
To study the outcomes of noninvasive ventilation (NIV) administered through a tabletop device for coronavirus disease 2019 acute respiratory distress syndrome in the respiratory intermediate care unit (RIMCU) at a tertiary care hospital in India.
We retrospectively studied a cohort of hospitalized patients deteriorating despite low-flow oxygen support who received protocolized management with positive airway pressure using a tabletop NIV device in the RIMCU as a step-up rescue therapy from July 30, 2020 to November 14, 2020. Treatment was commenced on the continuous positive airway pressure mode up to a pressure of 10 cm of HO, and if required, inspiratory pressures were added using the bilevel positive air pressure mode. Success was defined as weaning from NIV and stepping down to the ward, and failure was defined as escalation to the intensive care unit, the need for intubation, or death.
In total, 246 patients were treated in the RIMCU during the study period. Of these, 168 received respiratory support via a tabletop NIV device as a step-up rescue therapy. Their mean age was 54 years, and 83% were men. Diabetes mellitus (78%) and hypertension (44%) were the commonest comorbidities. Treatment was successful with tabletop NIV in 77% (129/168) of the patients; of them, 41% (69/168) received treatment with continuous positive airway pressure alone and 36% (60/168) received additional increased inspiratory pressure via the bilevel positive air pressure mode.
Respiratory support using the tabletop NIV device was an effective and economical treatment for coronavirus disease 2019 acute respiratory distress syndrome. Further studies are required to assess the appropriate time of initiation for maximal benefits and judicious utilization of resources.
在印度一家三级医院的呼吸中级护理病房（RIMCU）中，研究通过桌面设备对2019冠状病毒病急性呼吸窘迫综合征进行无创通气（NIV）的效果。
我们回顾性研究了一组住院患者，这些患者尽管接受了低流量氧疗仍病情恶化，于2020年7月30日至2020年11月14日在RIMCU接受了使用桌面NIV设备进行气道正压的标准化管理，作为逐步升级的抢救治疗。治疗从持续气道正压模式开始，压力最高达10 cmH₂O，如有需要，使用双水平气道正压模式增加吸气压力。成功定义为撤掉无创通气并转回病房，失败定义为升级至重症监护病房、需要插管或死亡。
在研究期间，RIMCU共治疗了246例患者。其中，168例接受了通过桌面NIV设备进行的呼吸支持作为逐步升级的抢救治疗。他们的平均年龄为54岁，83%为男性。糖尿病（78%）和高血压（44%）是最常见的合并症。77%（129/168）的患者使用桌面无创通气治疗成功；其中，41%（69/168）仅接受了持续气道正压治疗，36%（60/168）通过双水平气道正压模式额外增加了吸气压力。
使用桌面NIV设备进行呼吸支持是治疗2019冠状病毒病急性呼吸窘迫综合征的一种有效且经济的方法。需要进一步研究以评估开始治疗的合适时间，以实现最大效益并合理利用资源。
