Non-rebreather Research Articles

Oxygenation and Carbon Dioxide Rebreathing of a Well-fitting Non-rebreathing EcoLite™ Mask with a Reservoir: A Single-center Prospective Observational Study in Healthy Volunteers.

The fitting of oxygen mask affects the performance of it such as oxygenation or CO₂ elimination. The intersurgical EcoLite™ adult high-concentration oxygen mask (EcoLite with a reservoir, Intersurgical, UK) was developed to give well-fitting. The purpose of this study is to evaluate the performance of EcoLite with a reservoir compared to the conventional mask. Ten healthy volunteers were included in this study. EcoLite with a reservoir and conventional mask were given to patients at different oxygen flow rates (5, 8, 10, 12, and 15 L/min). Fraction of inspiratory O₂ (FIO₂) and partial pressure of inspiratory CO₂ (PICO₂) were measured by a sampling tube at the middle pharynx inserted via nose. The EcoLite with a reservoir had a significantly higher FIO₂ than the control reservoir mask. However, the PICO₂ was significantly higher in the EcoLite with a reservoir than in the control reservoir mask, especially when the oxygen flow rate was low. The EcoLite with a reservoir provided improved oxygenation and a better fit than the conventional reservoir masks in healthy volunteers. However, the EcoLite with a reservoir might cause higher CO₂ rebreathing at low oxygen flow rates.

Addition of Mask to High-flow Nasal Oxygen: A Strategy to Improve Oxygenation in Hypoxemic Respiratory Failure Secondary to COVID-19.

High-flow nasal cannula (HFNO) reduces the need for invasive mechanical ventilation in COVID-19 patients with hypoxemic-respiratory failure. During HFNO entrainment of room air dilutes the delivered fractional inspiratory oxygen (FiO2), thereby preventing improvement in oxygenation. The placement of a mask over HFNO to improve oxygenation has provided conflicting results. We aimed to determine and compare the effect of placing various mask types over HFNO on oxygen saturation (SPO2). In this prospective physiological study 40 patients with COVID-19-associated hypoxemic respiratory failure on HFNO with O2 concentration <92% were included. The effect of placing different masks over HFNO on oxygenation, respiratory rate, heart rate, blood pressure, patient comfort, and partial pressure of carbon dioxide level (pCO2) was recorded after a prespecified time interval. We observed a significantly higher mean SPO2 and lower mean respiratory rate on using various study masks over HFNO compared to HFNO alone. On comparing various mask types, the use of N95 masks and nonrebreather (NRB) masks with O2 showed a significant increase in O2 concentration and reduction in respiratory rate compared to surgical mask (SM) and NRB without O2. The proportion of patients who achieved SPO2 of >92% was higher with the use of N95 masks (47.5%) or NRB with O2 (45%) over HFNO compared to SM (35%) and NRB without O2 (35%). No significant change was observed in heart rate, blood pressure, and CO2 level with the use of any mask over HFNO. This study demonstrates improvement in oxygenation and reduction in respiratory rate with the use of various masks over HFNO in patients of COVID-19-related hypoxemic-respiratory-failure. Significantly greater benefit was achieved with the use of N95 or NRB with O2 compared to SM or NRB without O2.

Awake self-proning for COVID-19 non-intubated patients—a single-centered experience

BackgroundCOVID-19 patients with respiratory failure may need intensive care unit (ICU) admission. Prone positioning in mechanically ventilated patients improves oxygenation and reduces mortality in moderate to severe acute respiratory distress syndrome. For better oxygenation and outcomes, awake proning is being tried in non-intubated patients also. Our aim was to investigate advantage of awake self-prone positioning with oxygen therapy using non-rebreathing mask (NRBM) in COVID-19 ICU patients.ResultsThis prospective observational study was conducted in ICU from 18th November 2020 to 28th February 2021. Sixty COVID-19 cooperative patients with hypoxemia on arrival with hemodynamic stability were included. Patients on NRBM were advised to turn prone for 12–14 h per day. Oxygen saturation (SpO2) was recorded in supine position and 30 min after initiation of prone positioning. Ratio of arterial partial pressure of oxygen and fractional concentration of inspired oxygen (P/F) was recorded in supine and 24 h after initiation of prone position. Primary outcome was improvement in SpO2 > 94%. Secondary outcome was incidence of intubation.Sixty patients were received in ICU with supplemental oxygen, and median SpO2 was 80% (IQR 70–88%). Patients were put on NRBM with median SpO2 in supine position 86% (IQR 76–90). Thirty minutes of proning increased SpO2 to 94% (IQR 89 to 97%). Wilcoxon rank-sum test was used (P = 0.001). Forty-three patients did not require intubation, and seventeen patients needed intubation.ConclusionsAwake self-proning in COVID-19 patients on NRBM improved oxygenation with reduced intubation rate.

Role of Oxygenation in Moderate COVID-19 Pneumonia with High Flow Nasal Cannula and Standard Non-Rebreathing Mask: A Comparative Study

Background: To evaluate the effectiveness of High Flow Nasal Cannula (HFNC) and standard non rebreathing mask (NRBM) as oxygen delivery device, in moderate cases of COVID-19 Pneumonia. Methods: A single-centre, prospective analysis conducted at KBFGH. Eighty enrolled patients were randomly divided into two groups according to the oxygen delivery device used. Group 1 (n = 40) received HFNC and group 2 (n = 40) received NRBM as initial oxygen delivery device, to maintain a target saturation of e” 96% in both groups. The success rate of oxygen therapy, time to progression to severe disease, PaO2, PaO2/FiO2 ratio, respiratory rate, heart rate, blood pressure, number of patients requiring NIV or endotracheal intubation, time for de-escalation of oxygen therapy to lower Fio2 device and patient satisfaction level were compared among the two groups. Results: Demographic, clinical variables and treatment given were comparable in the two groups. In the HFNC group 83.3% patients had successful outcomes with the initial oxygen therapy device used as compared to 66.6% in the NRBM group. However, the use of HFNC resulted in improved oxygenation (P &lt; 0.001), better patient satisfaction (P &lt; 0.001) and shorter time for de-escalation of oxygen therapy to a lower FIO2 device (3.75 ± 1.032 vs. 6.83 ± 0.928). Conclusions: HFNC is a reliable oxygen therapy modality for moderate category COVID- 19 pneumonia that results in better oxygenation and a greater patient satisfaction level as compared to a non-rebreathing mask. Sir Salimullah Med Coll J 2023; 31: 79-85

Continuous aerosol monitoring and comparison of aerosol exposure based on smoke dispersion distance and concentrations during oxygenation therapy

This study evaluated the aerosol exposure risks while using common noninvasive oxygenation devices. A simulated mannequin was designed to breathe at a minute ventilation of 20 L/min and used the following oxygen-therapy devices: nasal cannula oxygenation (NCO) at 4 and 15 L/min, nonrebreathing mask (NRM) at 15 L/min, simple mask at 6 L/min, combination of NCO at 15 L/min and NRM at 15 L/min, high-flow nasal cannula (HFNC) at 50 L/min, and flush rate NRM. Two-dimension of the dispersion distance and the aerosol concentrations were measured at head, trunk, and foot around the mannequin for over 10 min. HFNC and flush-rate NRM yielded the longest dispersion distance and highest aerosol concentrations over the three sites of the mannequin than the other oxygenation devices and should use with caution. For flow rates of < 15 L/min, oxygenation devices with mask-like effects, such as NRM or NCO with NRM, decreased aerosol dispersion more effectively than NCO alone or a simple mask. In the upright position, the foot area exhibited the highest aerosol concentration regardless of the oxygenation device than the head–trunk areas of the mannequin. Healthcare workers should be alert even at the foot side of the patient while administering oxygenation therapy.

Pneumothorax occuring during the final stage of treatment in miliary tuberculosis patients

Air in the pleural space can cause lung collapse and respiratory discomfort, which can be life-threatening in very ill patients, making pneumothorax a medical emergency. Since tubercle bacilli can travel through the blood to the lungs and other organs, Miliary Tuberculosis (TB) is a disseminated disease that can be lethal. We present a case of a 36-year-old male with Pneumothorax Occuring during the Final Stage of Treatment in Million Tuberculosis Patients. The patient is currently undergoing outpatient treatment of miliary TB for the 11th month and so far his condition is getting better, however was admitted to the emergency unit of the hospital, diagnosed with left pneumothorax based on clinical, laboratory, and radiology showing. In meanwhile, 88% of the room air was saturated with oxygen, necessitating Intensive Care Unit treatment with HFNC FiO2 100 Flow 60, followed by high consentration oxygen therapy with a non-rebreathing mask (NRM) of 15 litres/minute. Combivent inhalation and pulmicort inhalation were given every 15 minutes. The family refused to install a water sealed drainage or chest tube in the patient. The patient was also given treatments with ceftriaxone, citicolin, methylprednisolone, omeprazole and the advanced phase of tuberculosis drugs namely Rifampicin 450 mg and Isoniazid 300 mg. On the 6th day of treatment in the ICU, the patient's condition improved and the pneumothorax decreased. In this case, the likelihood of Pneumothorax in patients with miliary tuberculosis needs to be emphasized, as well as the importance of evaluation and strict follow-up to prevent the occurrence of pneumothorax.

Clinical Observation of Hfnc Use Along With Non-rebreather Mask on Critical Covid-19 Diabetic Patients

Purpose: This study aimed to observe and compare the efficacy of High-flow Nasal Cannula (HFNC) with/without a non-rebreather mask (NRM) on ICU-admitted COVID-19 diabetic patients.&#x0D; Methodology: We collected epidemiological, biochemical, and clinical information from patients (diabetic = 136; non-diabetic = 104) admitted into four hospitals in Chattogram, Bangladesh. SPSS v25 was used to analyze the data with the Chi-Square, Fisher’s Exact, and Independent Samples T-test. We also built regression models to find out the impact of the variables.&#x0D; Results: Most of the patients with fever (59.1%) and hypertension (68.3%) had diabetes. We also noticed diabetic patients stayed in ICU longer (9.06±5.70) than non-diabetic patients (7.41±5.11). Moreover, elevated creatinine level was found in most diabetic cases (70.4%). After only HFNC administration, the partial pressure of oxygen significantly improved in non-diabetic patients. However, both diabetic and non-diabetic patients were observed to have an almost equal partial pressure of oxygen after HFNC with NRM management. Patients with elevated blood sugar additionally needed NRM more than fivefold compared to those with normal blood sugar levels. Besides, age and hypertension were significantly associated with HFNC+NRM-treated diabetic patients.&#x0D; Future Implications: The results of this study imply that oxygen supply with HFNC and NRM may be beneficial for elderly/hypertensive diabetic patients with COVID-19-associated AHRF; and that increased blood glucose level could be a determinant for the need for HFNC + NRM treatment.&#x0D; Bioresearch Commu. 9(2): 1285-1296, 2023 (July)

A Practical Solution for Preoxygenation in the Prehospital Setting: A Nonrebreather Mask with Flush Rate Oxygen

Objective Prehospital clinicians need a practical means of providing adequate preoxygenation prior to intubation. A bag-valve-mask (BVM) can be used for preoxygenation in perfect conditions but is likely to fail in emergency settings. For this reason, many airway experts have moved away from using BVM for preoxygenation and instead suggest using a nonrebreather (NRB) mask with flush rate oxygen. Literature on preoxygenation has suggested that a NRB mask delivering flush rate oxygen (on a 15 L/min O2 regulator, maximum flow, ∼50 L/min) is noninferior to BVM at 15 L/min held with a tight seal. However, in the prehospital setting, where emergency airway management success varies, preoxygenation techniques have not been deeply explored. Our study seeks to determine whether preoxygenation can be optimally performed with NRB at flush rate oxygen. Methods We performed a crossover trial using healthy volunteers. Subjects underwent 3-min trials of preoxygenation with NRB mask at 25 L/min oxygen delivered from a portable tank, NRB at flush rate oxygen from a portable tank, NRB with flush rate oxygen from an onboard ambulance tank, and BVM with flush rate oxygen from an onboard ambulance tank. The primary outcome was the fraction of expired oxygen (FeO2). We compared the FeO2 of the BVM-flush to other study groups, using a noninferiority margin of 10%. Results We enrolled 30 subjects. Mean FeO2 values for NRB-25, NRB-flush ambulance, NRB-flush portable, and BVM-flush were 63% (95% confidence interval [CI] 58–68%), 74% (95%, CI 70–78%), 78% (95%, CI 74–83%), and 80% (95%, CI 75–84%), respectively. FeO2 values for NRB-flush on both portable tank and ambulance oxygen were noninferior to BVM-flush on the ambulance oxygen system (FeO2 differences of 1%, 95% CI −3% to 6%; and 6%, 95% CI 1–10%). FeO2 for the NRB-25 group was inferior to BVM-flush (FeO2 difference 16%, 95% CI 12–21%). Conclusions Among healthy volunteers, flush rate preoxygenation using NRB masks is noninferior to BVM using either a portable oxygen tank or ambulance oxygen. This is significant because preoxygenation using NRB masks with flush rate oxygen presents a simpler alternative to the use of BVMs. Preoxygenation using NRB masks at 25 L/min from a portable tank is inferior to BVM at flush rate.

A Retrospective Analysis of Ventilatory Strategy Comparing Non-invasive Ventilation (NIV) With Invasive Ventilation in Patients Admitted With Severe COVID-19 Pneumonia.

Background The second wave of the COVID-19 pandemic in India saw a sudden upsurge of critically ill patients getting admitted to the ICU. The guidance for respiratory support wasunclearin the early phase. But later reports showed lower mortality with non-invasive ventilation (NIV) than with intubation. The aim of this study was to assess the end result of initial methods of ventilation in COVID-19 patients. Methodology Patients admitted to ICU with COVID-19 were categorized as group 1 (IPPV-intubated within 24 hrs of admission), group 2 (NIV -NIV only), group 3 (NIV+ IPPV-intubated after 24 hrs), and group 4 (NRBM - Non-Rebreathing Mask only).All causes in the hospital or 30-day mortality, length of stay in ICU, and incidence of pneumothorax were compared between groups. Logistic regression analysis was done to determine the odds of mortality. Results The overall mortality rate among patients admitted to tertiary care centers was 15% and the rate among patients in ICU was 54.07%. Patients in group 1 and group 3 had significantly high mortality rates of 90.47% and 93.75%, respectively, as compared to 51.28% in group 2 patients. The odds of mortality were high in group 3 (OR 29.57, 95% CI 4.51 and 193.52) and group 1 (OR 8.01, 95% CI 1.35 and 47.48). Conclusion In a resource-limited setting, the use of NIV is associated with higher survival in COVID-19 patients. The prognosis of patients who are intubated early or after a trial of NIV is the same with increased odds of mortality.

A case control investigation of COVID-19 associated mucormycosis in India

BackgroundIncreased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM.MethodsEleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls.ResultsCAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls.ConclusionsAppropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.

Abstract 167: Nasal Sensor Capnographic Differences In Major Traumatic Brain Injury Patients Receiving Non-rebreather Mask Versus Nasal Cannula Oxygen Delivery

Background: The advent of highly sensitive End-Tidal CO2 (ETCO2) sensors allows effective monitoring of intubated patients in EMS. Previous work has explored the use of ETCO2 monitoring in non-intubated patients with sensors placed in the nares. However, little is known about the effect of passive O2 delivery [nasal cannula (NC) or high-flow, non-rebreather mask (NRB)] on ETCO2 measurement. Objective: To compare ETCO2 measurements in non-intubated Traumatic Brain Injury (TBI) patients receiving O2 via NC vs. NRB in the field. Methods: A subset of cases from the EPIC EMS TBI Study (NIH-1R01NS071049) were evaluated (4/13-4/18). Non-intubated cases from 5 EMS agencies providing monitor data, including continuous ETCO2. Start and end segments were excluded to remove artifact from initiation (“ramp-up”) or termination of monitoring. Statistics: Wilcoxon rank-sum test, two-sample t-test, and Chi-squared test were used as appropriate. Linear regression compared continuous variables in adjusted analyses (α = 0.05). Results: Included were 151 cases [median age: 52 (range: 9-91; 66% male)]. Of those, 62 (41%) received NCO2 and 89 (59%) via NRB. Patient-level mean ETCO2 was slightly lower in the NC group (mean = 26.9 mmHg; SD 6.7) compared to NRB (mean 30.2; SD 8.1; p=0.007). Differences in the mean were: Unadjusted: 3.3 (95% CI 0.9-5.7); Adjusted 2.7 (0.2-5.2). There were no significant differences in means of the patient-level lowest or highest recorded values. Conclusion: While there was a statistically lower ETCO2 in the NC versus NRB-oxygenated patients, it was around 3 mmHg and, thus, not clinically significant. This is surprising since: 1) the O2 flow rates and 2) the open-air (NC) versus mask (NRB) delivery methods are so dramatically different. Future study is needed to identify the clinical implications of using noninvasive ETCO2 measurement as a tool for monitoring ventilatory status and changes in non-intubated TBI (and other) patients in emergency settings.

Characteristics and Predictive Value of T-lymphocyte Subset Absolute Counts in Patients with COVID-19-associated Acute Respiratory Failure: A Retrospective Study.

Of the factors influencing severity and outcomes following coronavirus disease-2019 (COVID-19), cellular immune response has a strong impact. The spectrum of response varies from over-activation to hypo-functioning. The severe infection leads to reduction in numbers and dysfunction of T-lymphocytes/subsets. This retrospective, single-center study aimed to analyze the expression of T-lymphocyte/subsets by flow cytometry and inflammation-related biomarker, serum ferritin in real-time polymerase chain reaction (RT-PCR) positive patients. According to oxygen requirements, patients were stratified into nonsevere (room air, nasal prongs, and face mask) and severe [nonrebreather mask (NRBM), noninvasive ventilation (NIV), high-flow nasal oxygen (HFNO), and invasive mechanical ventilation (IMV)] subgroups for analysis. Patients were classified into survivors and nonsurvivors. Mann-Whitney U test was used to analyze differences in T-lymphocyte and subset values when classified according to gender, the severity of COVID, outcome, and prevalence of diabetes mellitus (DM). Cross tabulations were computed for categorical data and compared using Fisher's exact test. Spearman correlation was used to analyze the correlation of T-lymphocyte and subset values with age or serum ferritin levels. p <0.05 values were considered to be statistically significant. A total of 379 patients were analyzed. Significantly higher percentage of patients with DM were aged ≥61 years in both nonsevere and severe COVID groups. A significant negative correlation of CD3+, CD4+, and CD8+ was found with age. CD3+ and CD4+ absolute counts were significantly higher in females as compared to males. Patients with severe COVID had significantly lesser total lymphocyte (%), CD3+, CD4+, and CD8+ counts as compared to those with nonsevere COVID (p <0.05). T-lymphocyte subsets were reduced in patients with severe disease. A significant negative correlation of total lymphocyte (%), CD3+, CD4+, and CD8+ counts was found with serum ferritin levels. T-lymphocyte/subset trends are an independent risk factor for clinical prognosis. Monitoring may help in intervening in patients with disease progression. Vadi S, Pednekar A, Suthar D, Sanwalka N, Ghodke K, Rabade N. Characteristics and Predictive Value of T-lymphocyte Subset Absolute Counts in Patients with COVID-19-associated Acute Respiratory Failure: A Retrospective Study. Indian J Crit Care Med 2022;26(11):1198-1203.

Comparison of high-flow nasal cannula oxygen therapy and non-rebreather face mask in the treatment of mild carbon monoxide poisoning

Objective: To compare the efficacy of high-flow nasal cannula oxygen therapy (HFNC) and non-rebreather face mask (NRFM) in the treatment of mild acute carbon monoxide poisoning (ACOP) in reducing carboxyhemoglobin (COHb) , and to explore the feasibility of HFNC in the treatment of ACOP. Methods: Patients with mild ACOP with COHb >10% who were admitted to the emergency department of Northern Jiangsu People's Hospital from January 2015 to December 2020 were analyzed, and those with altered consciousness, mechanical ventilation and those requiring hyperbaric oxygen therapy were excluded. The patients were divided into HFNC group and NRFM group according to the oxygen therapy used in the emergency department. The COHb decline value and COHb half-life in the two groups were observed. Results: Seventy-one patients were enrolled, including 39 in the NRFM group and 32 in the HFNC group. The baseline COHb in the HFNC group was 24.8%±8.3%, and that in the NRFM group was 22.5%±7.1%, with no significant difference between the two groups (t=1.27, P=0.094) . At 60 min, 90 min and 120 min of treatment, COHb in both groups decreased, but the COHb in HFNC group was lower than that in NRFM group at the same time point (P<0.05) . After 1 h of treatment, the COHb decrease in the HFNC group (16.9%±4.5%) was significantly higher than that in the NRFM group (10.1%±7.8%) (t=4.32, P=0.013) . The mean half-life of COHb in the HFNC group (39.3 min) was significantly lower than that in the NRFM group (61.4 min) (t=4.69, P=0.034) . Conclusion: HFNC treatment of mild ACOP can rapidly reduce blood COHb level, it is a potential oxygen therapy method for clinical treatment of ACOP.

Effect of Tocilizumab on Clinical Outcome in Patients with Severe COVID-19 Pneumonia

In severe Covid-19 pneumonia, acute respiratory distress syndrome (ARDS) associated with cytokine storm is the leading cause of death. Tocilizumab was approved for chimeric antigen receptor T-cell therapy induced cytokine release syndrome and it may provide clinical benefit in these severe covid-19 pneumonia. In this retrospective cohort study, we evaluated patients with severe COVID-19 pneumonia admitted between May 2021 and June, 2021. Patients who were received tocilizumab during treatment, were enrolled for the study. Systemic steroids, hydroxychloroquine, and azithromycin were concomitantly used for the patients. The outcome was measured as an improvement in peripheral oxygen saturation by change in mode of oxygen therapy and improvement in laboratory parameters after tocilizumab administration. Out of 23 treated patients (18 Male, 5 Females), 19 patients received a single dose of tocilizumab and another four patients received two doses of it. Of these 23 patients, 3/3 with NRBM (non-rebreather mask) showed improvement and shifted to nasal cannula for oxygenation. 11/12 patients with NIV(non-invasive) showed improvement. 5/8 patients with invasive ventilation showed gradual improvement and shifted to NIV. A total of 4/23 (17%) patients didn’t show any improvement and died. Inflammatory markers like CRP, percentage of lymphocytes, and ferritin also showed significant improvement after administration of tocilizumab. Our study showed that in patients with severe COVID-19, tocilizumab was associated with significant improvement in clinical and laboratory parameters. These findings require further validation from ongoing clinical trials of Tocilizumab in COVID-19 patients.

An analysis of the treatment effect of two modes of oxygenation on patients with radiation pneumonia complicated by respiratory failure.

Stereotactic radiotherapy (SBRT) is widely used in the treatment of thoracic cancer. To evaluate the efficacy of a non-rebreather mask (NRBM) and high-flow nasal cannula (HFNC) in patients with radiation pneumonia complicated with respiratory failure. This was a single-center randomized controlled study. Patients admitted to the EICU of the Fourth Hospital of Hebei Medical University were selected and divided into NRBM and HFNC group. Arterial blood gas analysis, tidal volume, respiratory rates and the cases of patients receiving invasive assisted ventilation were collected at 0, 4, 8, 12, 24, 48, and 72 h after admission. (1) The PaO2/FiO2, respiratory rates, and tidal volume between the two groups at 0, 4, 8, 12, 24, 48, and 72 h were different, with F values of 258.177, 294.121, and 134.372, all P< 0.01. These indicators were different under two modes of oxygenation, with F values of 40.671, 168.742, and 55.353, all P< 0.01, also varied with time, with an F value of 7.480, 9.115, and 12.165, all P< 0.01. (2) The incidence of trachea intubation within 72 h between HFNC and NRBM groups (23 [37.1%] vs. 34 [54.0%], P< 0.05). The transition time to mechanical ventilation in the HFNC and NRBM groups (55.3 ± 3.2 h vs. 45.9 ± 3.6 h, P< 0.05). (3) The risk of intubation in patients with an APACHE-II score > 23 was 2.557 times than score ⩽ 23, and the risk of intubation in the NRBM group was 1.948 times more than the HFNC group (P< 0.05). Compared with the NRBM, HFNC can improve the oxygenation state of patients with radiation pneumonia complicated with respiratory failure in a short time, and reduce the incidence of trachea intubation within 72h.

Primary Breathing Survey Emergency with Oxygen Need Optimization and Nurse Caring on Covid-19 Patients in IGD UKI RSU Jakarta: Case Study

Emergency in Covid-19 is a respiratory tract infection caused by a new type of coronavirus (SARS-CoV-2) so that it can cause a decrease in oxygen levels in patients with saturation &lt;95% Objective: To carry out emergency nursing care for19 patients Covid-. 19 with the measures in Primary Survey and Secondary Survey order to increase oxygen saturation &gt;95%, reduce shortness of breath, regular breathing rhythm with a frequency of 20x/minute, symmetrical chest movements, and no chest muscle retraction Methods: The method of case study results uses a descriptive approach with a process approach. nursing care, independent action by monitoring the frequency of breath and oxygen saturation as well as giving the semi-fowler position, collaborative action by giving high concentration oxygen Non-Rebreathing Mask 10 liters/minute. Results: The patient's shortness of breath has been reduced with oxygen saturation increasing 99%, chest movement is symmetrical, irregular breathing rhythm 24x/minute is still partially resolved and the patient does not appear restless after being given high concentrations of oxygen. Conclusion: It takes speed and attitude caring towards patients to overcome anxiety and empathy, especially being a good listener by always providing support so that patients are always motivated to recover and providing independent action and the right collaboration of health workers so that the handling of Covid-19 can be resolved

Supplementation of High Velocity Nasal Insufflation with a Nonrebreather Mask for Severe Hypoxemic Respiratory Failure in Adult Patients with COVID-19

The unique clinical features of COVID-19-related acute hypoxemic respiratory failure, as well as the widespread impact leading to resource strain, have led to reconsiderations of classic approaches to respiratory support. HFNO includes high flow nasal cannula (HFNC) and high velocity nasal insufflation (HVNI). There are currently no widely accepted criteria for HFNO failure. We report a series of three patients who experienced COVID-19-related acute severe hypoxemic respiratory failure. Each patient was initially managed with HVNI and had a ROX index < 3.85, suggesting HFNO failure was likely. They were subsequently managed with a nonrebreather mask (NRM) overlying and in combination with HVNI at maximal settings and were able to be managed without the need for invasive mechanical ventilation.

The effectiveness of high-flow nasal cannula and standard non-rebreathing mask for oxygen therapy in moderate category COVID-19 pneumonia: Randomised controlled trial.

Background COVID-19 caused by the highly infectious severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is a matter of concern and has led to severe health problems all over the world. Oxygen therapy is the mainstay for the management of patients suffering from various stages of the disease. Objectives To compare the effectiveness of high-flow nasal cannula (HFNC) and standard non-rebreathing mask (NRBM) as oxygen delivery devices in moderate cases of COVID-19 pneumonia. Methods A single-centre, open-label, randomised controlled trial was conducted between February 2021 and April 2021. All the enrolled patients (N=120) were randomly allocated into two groups according to the oxygen delivery device used. Group 1 (n=60) received HFNC and group 2 (n=60) received NRBM as the initial oxygen delivery device, to maintain a target saturation ≥96% in both groups. The progression-free survival without escalation of respiratory support, partial pressure of arterial oxygen (PaO2 ), a ratio of partial pressure of arterial oxygen to fractional inspiratory oxygen concentration (PaO2 /FiO2 ), respiratory rate, heart rate, blood pressure, number of patients requiring non-invasive ventilation or endotracheal intubation, time for de-escalation of oxygen therapy to lower FiO2 device, time to progression to severe disease, survival at day 28, and patient satisfaction level were compared between the two groups. Results Demographic, clinical variables and treatment received were comparable in the two groups. In the HFNC group, 90% of patients had successful outcomes with the initial oxygen therapy device used as compared with 56.6% in the NRBM group (p<0.001; odds ratio (OR) 0.145; 95% confidence interval (CI) 0.054 - 0.389). Using HFNC also resulted in improved oxygenation (PaO2 /FiO2 ) (p<0.001), better patient satisfaction (p<0.001), and a shorter time for de-escalation of oxygen therapy to a lower FiO2 device (p<0.001). The 28-day survival was higher in the HFNC group, but the difference was statistically insignificant (p=0.468). Conclusion HFNC is a reliable oxygen therapy modality for moderate category COVID-19 pneumonia and results in a higher success rate of oxygen therapy, better oxygenation, and a greater patient satisfaction level as compared with a NRBM.

A retrospective study of association of CT severity with clinical profile and outcomes of patients with COVID-19 in the second wave

ObjectivesThis study aimed to find out the association of CT severity score with demographic and clinical characteristics as well as mortality in the patients who were confirmed to have COVID-19 disease in the second wave.Material and MethodsThis retrospective study included collection and assessment of the demographic, clinical, laboratory data, and mortality of the patients, suspected with COVID-19 infection who underwent chest HRCT scan during March to April 2021. The findings of the chest HRCT were retrieved manually from the Medical Records section. Determination of the severity was done by the scoring system that involved the visual evaluation of the affected lobes.ResultsCT severity score was mild, moderate, and severe in 21.94%, 41.60%, and 30.48% patients, respectively. Mortality rate was 5.70%. Age of the patients with mild, moderate, and severe CT severity score was significantly more than those with normal severity score (50 vs. 50 vs. 50 vs. 31, P=0.0009). When compared to patients with normal score, those with mild, moderate, and severe CT severity score had significantly higher dyspnoea (10.39% vs. 67.81% vs. 97.20% vs. 0%), significantly more cases with diabetes mellitus (16.88% vs. 25.34% vs. 31.78% vs. 9.52%, P=0.044), hypertension (27.27% vs. 21.23% vs. 32.71% vs. 4.76%, P=0.026), and obesity (6.49% vs. 8.90% vs. 23.36% vs. 0%, P=0.0005). Total leucocyte counts, absolute neutrophil counts, creatinine, serum glutamic pyruvic transaminase (SGPT), lactate dehydrogenase (LDH), ferritin, and D-dimer were deranged in significantly more patients of severe score (53.27%, 62.62%, 60.75%, 85.05%, 90.65%, 97.20%, and 95.35%, respectively). Interleukin-6 (IL-6) and C-reactive protein were deranged in significantly more patients with moderate disease (98.18% and 98.63%, respectively). Increasing severity scores were associated with increased mortality (mild vs. moderate vs. severe: 1.30% vs. 1.37 vs. 15.89%, P<.0001). Oxygen saturation (SpO2) was significantly lowest in severe score followed by moderate, mild and normal scores (87 vs. 90 vs. 96 vs. 97, P<.0001). Duration of non-rebreather mask (NRBM), noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), Venture/face mask, and intubation was also associated with increasing severity scores (P<0.0001).ConclusionCT scans play an important role in guiding physicians with their management plans and can serve as a predictor of disease severity and outcomes.

The Aerosol-Generating Effect Among Noninvasive Positive Pressure Ventilation, High-Flow Nasal Cannula, Nonrebreather Mask, Nasal Cannula, and Ventilator-Assisted Preoxygenation

To evaluate aerosol dispersion and exposure risk during oxygenation therapy among health care personnel. This study compared the aerosol dispersion effect produced through continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), BiPAP with face coverings, a high-flow nasal cannula (HFNC) with face coverings, nasal cannula oxygenation (NCO) at 15 L/min with face coverings, nonrebreather mask (NRM), and ventilator-assisted preoxygenation (VAPOX) during oxygenation therapy at a minute ventilation of 10 L/min and 20 L/min. The length and width of aerosol dispersion were recorded, and aerosol concentrations were then detected at a mannequin's head, trunk, and feet. The average length dispersion distance of CPAP was 47.12 cm (SD, 12.56 cm), of BiPAP was 100.13 cm (SD, 6.03 cm), of BiPAP with face coverings was 62.20 cm (SD, 8.46 cm), of HFNC with face coverings was 67.09 cm (SD, 12.74 cm); of NCO with face coverings was 85.55 cm (SD, 7.28 cm); and of NRM was 63.08 cm (SD, 15.33 cm); VAPOX showed no visible dispersion. The aerosol concentrations at the feet under CPAP and at the head under BiPAP were significantly higher than those observed without an oxygen device. Compared with no oxygen device, the aerosol concentration with HFNC was higher at the mannequin's head, trunk, and feet; whereas it was lower with VAPOX and NRM. Moreover, when translated to the number of virus particles required to infect medical personnel (Nf), VAPOX took more time to achieve Nf than other devices. Strong flow from the oxygenation devices resulted in increased aerosol concentrations. CPAP at the feet side, BiPAP at the head side, HFNC, and NCO with face coverings significantly increase aerosol exposure and should be used with caution. Aerosol concentrations at all positions were lower with NRM and VAPOX.