Abstract
Background:Moving away from invasive ventilation towards timed position change and non-invasive ventilation is especially of benefit in low and middle income countries, where judicious use of the available healthcare resources is the need of the day. Our study was conducted prospectively to develop strategies for non-invasive ventilation in combination with timed position change of patients to see its impact on their outcome.Objectives:Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury. The objective of this prospective, cross sectional study was to develop a protocol for the use of non-invasive ventilation with timed position change to improve COVID-19 patients’ outcomes in the Emergency Department (ED).Methods:All patients presenting with confirmed or suspected COVID-19 were enrolled in the study from March 2020 to October 2020. Data was collected to see the effect of timed position change and non-invasive ventilation on these patients and its effect on delaying or avoiding invasive ventilation.Results:Of the 207 COVID-19 patients presenting to the IHHN ED, 109(52.7%) had oxygen saturation in the nineties in supine position followed by right lateral in 37(17.9%), sitting up in 30(14.5%), left lateral in 29(14%) and prone position in 2(1%). Maximal oxygenation was achieved with non rebreather mask (NRM) and nasal prongs in 87(42%) of the patients, followed by the use of continuous positive airway pressure (CPAP) in 29(14%).Conclusion:Most of the patients preferred to stay in the supine position and described it as the position of comfort. When used in combination supine position, patients on NRM with nasal prongs and on CPAP, had oxygen saturation in the nineties. Central obesity was found to be the prime reason for the inability to prone our patients. This needs to be followed up in the current fourth wave of COVID-19 to see the effectiveness of the said modalities.
Highlights
With the COVID-19 pandemic in its fourth wave, critically ill patients are coming to Emergency Department (ED) with hypoxia, bilateral lung injury and post COVID sequelae
A prospective, cross sectional study was conducted to see the effects of timed position change and non-invasive ventilation modalities in patients with suspected or diagnosed COVID-19, who came to our ED at The Indus Hospital and Health Network (IHHN), Karachi from March 2020 to October 2020
Non availability of beds resulted in 40 (19.3%) patients referral to other facilities, 7 (3.4%) patients left against medical advice (LAMA), 6 (2.9%) were discharged and 12 (5.8%) expired in
Summary
With the COVID-19 pandemic in its fourth wave, critically ill patients are coming to EDs with hypoxia, bilateral lung injury and post COVID sequelae. Pak J Med Sci January 2022 Vol 38 No 2 Special Issue www.pjms.org.pk 375 with COVID Most of these were initially focused on early intubation and ventilation and led to a gross overburden of the health-care system in terms of human resource and availability of intensive care unit (ICU) beds and mechanical ventilators.[1] This led to research to delay or forego invasive ventilation and improve oxygenation through modalities of timed position change and non-invasive ventilation in patients with COVID-19. Objectives: Non-invasive ventilation has proven to be of benefit in COVID-19 related acute lung injury The objective of this prospective, cross sectional study was to develop a protocol for the use of noninvasive ventilation with timed position change to improve COVID-19 patients’ outcomes in the Emergency Department (ED). This needs to be followed up in the current fourth wave of COVID-19 to see the effectiveness of the said modalities
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