scholarly journals A short course of prednisolone in patients with moderate Covid 19 respiratory failure- stop the progression a case series.

2021 ◽  
Author(s):  
Dale Ventour ◽  
Rheana Sieunarine ◽  
Chavin Gopaul
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Medical Center ◽  
Case Series ◽  
Signs And Symptoms ◽  
Respiratory Support ◽  
High Dependency Unit ◽  
Supplementary Oxygen ◽  
Non Invasive ◽  
High Dependency

Abstract Introduction This case series outlines the results of using prednisolone in patients with moderated respiratory failure secondary to Covid 19 pneumonitis to prevent the progression to invasive ventilation. There is no consensus on the use of prednisolone in Moderate Covid respiratory failure early in the pandemic this should be an additional option where Dexamethasone is not available. Consent was obtained by the patients for anonymous publication of their data.Clinical Findings The author provides evidence of four (4) Covid 19 positive cases admitted to the High dependency Unit with moderate respiratory failure, defined as needing supplementary oxygen therapy to maintain saturations above 90%, who when treated with prednisolone rapidly decreased their oxygen requirement and were successfully weaned to room air within 72 hours of initiation of steroids.Diagnosis Four (4) patients admitted to the High Dependency Unit diagnosed with moderate respiratory failure secondary to PCR positive Covid 19.Intervention Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15-30mg until they were weaned to room air maintaining saturations >95%.Outcome Rapid resolution of worsening respiratory function of Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms which none of them had.Conclusion Initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.

scholarly journals Medical High Dependency Unit series, Article 3: Respiratory Support in the MHDU

2017 ◽  
Vol 16 (3) ◽  
pp. 115-122
Author(s):  
Christopher John Wright ◽  
◽  
Russell Morton Allan ◽  
Stuart A Gillon ◽  
◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Key Management ◽  
Respiratory Support ◽  
Severe Respiratory Failure ◽  
High Dependency Unit ◽  
Non Invasive ◽  
High Dependency ◽  
Threatening Condition ◽  
Life Threatening

Acute respiratory failure is a life threatening condition encountered by Acute Physicians; additional non-invasive support can be provided within the medical high dependency unit (MHDU). Acute Physicians should strive to be experts in the investigation, management and support of patients with acute severe respiratory failure. This article outlines key management principles in these areas and explores common pitfalls.

scholarly journals Prolonged non-invasive respiratory support in a COVID-19 patient with severe acute hypoxemic respiratory failure

2021 ◽  
Author(s):  
Andrea Lanza ◽  
Maurizio Sommariva ◽  
Sara Mariani ◽  
Gabriela Ferreyra ◽  
Giuliana Enrica Stagni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Ventilatory Support ◽  
Respiratory Support ◽  
Low Flow ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
High Dependency ◽  
Non Invasive Ventilation ◽  
Experienced Team

A pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 was declared in 2020. Severe cases were characterized by the development of acute hypoxemic respiratory failure (AHRF) requiring advanced respiratory support. However, intensive care units (ICU) were saturated, and many patients had to be treated out of ICU. This case describes a 75-year-old man affected by AHRF due to Coronavirus Disease 2019 (COVID-19), hospitalized in a high-dependency unit, with PaO2/FiO2 <100 for 28 consecutive days. An experienced team with respiratory physiotherapists was in charge of the noninvasive ventilatory support (NIVS). The patient required permanent NIVS with continuous positive airway pressure, non-invasive ventilation, high flow nasal oxygen and body positioning. He was weaned from NIVS after 37 days and started exercise training afterwards. The patient was discharged at home with low-flow oxygen therapy. This case represents an example of a successful treatment of AHRF with the still controversial noninvasive respiratory support in one patient with COVID-19.

scholarly journals Integrated oxygen therapy consisting of non invasive ventilation and nasal cannulae in respiratory failure secondary to COVID-19 pneumonia: Case series

2021 ◽  
Vol 8 (4) ◽  
pp. 45-48
Author(s):  
Anshul Singh ◽  
Suman Choudhary ◽  
Ashok Kumar Saxena
Keyword(s):  
Respiratory Failure ◽  
Oxygen Therapy ◽  
Work Of Breathing ◽  
Case Series ◽  
Invasive Ventilation ◽  
Hypoxemic Respiratory Failure ◽  
Non Invasive ◽  
Nasal Cannulae ◽  
Non Invasive Ventilation ◽  
Early Intubation

Patients with moderate to severe COVID-19 disease develop hypoxemic respiratory failure demonstrating profound degrees of hypoxia with little or no distress. This has put the conventional management consisting of an early intubation in question. In this case series, we attempted an integrated oxygen strategy utilizing non invasive ventilation with standard oxygen therapy (SO) via nasal cannula. We managed both the patients with successful outcomes, without the need of intubation. Hence, integrated oxygen therapy was successfully utilized for the ventilatory management of moderate to severe COVID-19 patients by improving oxygenation, making patients more comfortable and reducing the work of breathing. By complete avoidance of intubation, this technique might help in preservation of much-needed critical care ventilators and help improve patient outcomes in the areas hit hard by the pandemic.

scholarly journals Is continuous positive airway pressure (CPAP) a new standard of care for type 1 respiratory failure in COVID-19 patients? A retrospective observational study of a dedicated COVID-19 CPAP service

2020 ◽  
Vol 7 (1) ◽  
pp. e000639 ◽  
Author(s):  
Rebecca Nightingale ◽  
Nneka Nwosu ◽  
Farheen Kutubudin ◽  
Tom Fletcher ◽  
Joe Lewis ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Case Series ◽  
Standard Of Care ◽  
High Dependency Unit ◽  
High Dependency ◽  
Disease Unit

The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.

scholarly journals Comparison of high-flow nasal oxygen therapy and non-invasive ventilation in ICU patients with acute respiratory failure and a do-not-intubate orders: a multicentre prospective study OXYPAL

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045659
Author(s):  
René Robert ◽  
Denis Frasca ◽  
Julie Badin ◽  
C Girault ◽  
Christophe Guitton ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Oxygen Therapy ◽  
High Flow ◽  
Invasive Ventilation ◽  
Clinical Practices ◽  
Icu Patients ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Registration Number

IntroductionA palliative approach to intensive care unit (ICU) patients with acute respiratory failure and a do-not-intubate order corresponds to a poorly evaluated target for non-invasive oxygenation treatments. Survival alone should not be the only target; it also matters to avoid discomfort and to restore the patient’s quality of life. We aim to conduct a prospective multicentre observational study to analyse clinical practices and their impact on outcomes of palliative high-flow nasal oxygen therapy (HFOT) and non-invasive ventilation (NIV) in ICU patients with do-not-intubate orders.Methods and analysisThis is an investigator-initiated, multicentre prospective observational cohort study comparing the three following strategies of oxygenation: HFOT alone, NIV alternating with HFOT and NIV alternating with standard oxygen in patients admitted in the ICU for acute respiratory failure with a do-not-intubate order. The primary outcome is the hospital survival within 14 days after ICU admission in patients weaned from NIV and HFOT. The sample size was estimated at a minimum of 330 patients divided into three groups according to the oxygenation strategy applied. The analysis takes into account confounding factors by modelling a propensity score.Ethics and disseminationThe study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.Trial registration numberNCT03673631

Department of Internal Medicine. University Hospital of Patras. Patras.

2022 ◽  
Vol 35 (13) ◽  
Author(s):  
Themistoklis Paraskevas ◽  
Eleousa Oikonomou ◽  
Maria Lagadinou ◽  
Vasileios Karamouzos ◽  
Nikolaos Zareifopoulos ◽  
...  
Keyword(s):  
Oxygen Therapy ◽  
Case Series ◽  
High Flow ◽  
University Hospital ◽  
Current Evidence ◽  
Cochrane Library ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
High Flow Oxygen

Introduction: Oxygen therapy remains the cornerstone for managing patients with severe SARS-CoV-2 infection and several modalities of non-invasive ventilation are used worldwide. High-flow oxygen via nasal canula is one therapeutic option which may in certain cases prevent the need of mechanical ventilation. The aim of this review is to summarize the current evidence on the use of high-flow nasal oxygen in patients with severe SARS-CoV-2 infection.Material and Methods: We conducted a systematic literature search of the databases PubMed and Cochrane Library until April 2021 using the following search terms: “high flow oxygen and COVID-19” and “high flow nasal and COVID-19’’.Results: Twenty-three articles were included in this review, in four of which prone positioning was used as an adjunctive measure. Most of the articles were cohort studies or case series. High-flow nasal oxygen therapy was associated with a reduced need for invasive ventilation compared to conventional oxygen therapy and led to an improvement in secondary clinical outcomes such as length of stay. The efficacy of high-flow nasal oxygen therapy was comparable to that of other non-invasive ventilation options, but its tolerability is likely higher. Failure of this modality was associated with increased mortality.Conclusion: High flow nasal oxygen is an established option for respiratory support in COVID-19 patients. Further investigation is required to quantify its efficacy and utility in preventing the requirement of invasive ventilation.

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