Abstract
Noninvasive ventilation (NIV) has a controversial role in treating acute hypoxemic respiratory failure in Severe COVID-19 disease. Noninvasive ventilation has been known to avoid intubation and prevent complications associated with mechanical ventilation, but the risk of aerosolization and consequent contraction of disease deterred clinicians from using it.: The medical records of 18 patients having severe COVID -19 disease with Acute respiratory distress syndrome (ARDS), who received NIV therapy in a tertiary care hospital were scrutinized from a period of 15 June 2020 to 28 June 2020. The parameters like respiratory rate (RR)and PaO2/FiO2(PF ratio) and SOFA score were collected from the day of admission to 5th day of ICU stay. Other parameters like outcomes of NIV therapy, complications and time taken from weaning from NIV were recorded. Forty-five health care workers, involved in the treatment were educated about use of PPE and NIV and were tested for COVID -19 by RT-PCR post-ICU rotation.: The statistical analysis was done by statistical package for social science version(SPSS) 22.0. The parameters were compared by using repeated measure analysis of variance.The mean age group of the patient in the study was 47.44 years. The respiratory rate and PaO2/FIO2 at the time of ICU admission were 29.28±3.74 per minute and 121.06±29.05 respectively. There was significant improvement in PF ratio throughout the observation (p=0.021) and the respiratory rate decreased after NIV therapy from the day of admission to the subsequent days (p=0.001). The major proportion (i.e. 88.8%) of patients with ARDS but SOFA score <5, had a favorable outcome with NIV therapy. 45 HCWs tested negative for SARS-CoV-2. Non-invasive ventilation can be safely used as an effective therapy for moderate to severe ARDS due to COVID-19 disease.
Highlights
Noninvasive ventilation (NIV) has a controversial role in treating acute hypoxemic respiratory failure in Severe COVID-19 disease
14% of COVID 19 patients develop severe disease, which includes patients suffering from pneumonia, acute respiratory distress syndrome(ARDS), and sepsis
7 Treating hypoxemia with oxygen therapy, with or without mechanical ventilation is a mainstay of treatment in severe COVID 19 disease
Summary
Noninvasive ventilation (NIV) has a controversial role in treating acute hypoxemic respiratory failure in Severe COVID-19 disease. Noninvasive ventilation has been known to avoid intubation and prevent complications associated with mechanical ventilation, but the risk of aerosolization and consequent contraction of disease deterred clinicians from using it. High flow nasal cannula (HFNC), Noninvasive ventilation (NIV), and mechanical ventilation are some of the methods of oxygen therapy in severe cases of COVID-19 disease. Dalal and Das / Panacea Journal of Medical Sciences 2021;11(2):[209–215] patients were put on NIV therapy but the risk of aerosol dispersion associated with NIV therapy and consequent contraction of COVID-19 disease was a constant fear amongst health care workers. Complications of invasive mechanical ventilation in Severe COVID-19 diseases like high rate of mortality, difficult weaning, barotrauma, and Ventilator-associated pneumonia(VAP) have led to renewed interest in the utility of NIV3. The theoretical risk of dispersion of aerosol and self-induced lung injury prevents clinicians from using NIV. 4,5
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