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VOLUME 26 , ISSUE 7 ( July, 2022 ) > List of Articles

Original Article

Noninvasive Respiratory Assist Devices in the Management of COVID-19-related Hypoxic Respiratory Failure: Pune ISCCM COVID-19 ARDS Study Consortium (PICASo)

Sameer Jog, Manasi Shahane, Kapil Borawake, Zafer Khan, Ashwini Jahagirdar, Venkatesh Dhat, Pradeep D'costa, Jayant Shelgaonkar, Abhijit Deshmukh, Khalid Khatib

Keywords : High-flow nasal oxygen, Mechanical ventilation, Moderate-to-severe acute respiratory distress syndrome, Noninvasive ventilation

Citation Information : Jog S, Shahane M, Borawake K, Khan Z, Jahagirdar A, Dhat V, D'costa P, Shelgaonkar J, Deshmukh A, Khatib K. Noninvasive Respiratory Assist Devices in the Management of COVID-19-related Hypoxic Respiratory Failure: Pune ISCCM COVID-19 ARDS Study Consortium (PICASo). Indian J Crit Care Med 2022; 26 (7):791-797.

DOI: 10.5005/jp-journals-10071-24241

License: CC BY-NC 4.0

Published Online: 15-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Objective: To determine whether high-flow nasal oxygen (HFNO) or noninvasive ventilator (NIV) can avoid invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (ADRS), and the outcome predictors of these modalities. Design: Multicenter retrospective study conducted in 12 ICUs in Pune, India. Patients: Patients with COVID-19 pneumonia who had PaO2/FiO2 ratio <150 and were treated with HFNO and/or NIV. Intervention: HFNO and/or NIV. Measurements: The primary outcome was to assess the need of IMV. Secondary outcomes were death at Day 28 and mortality rates in different treatment groups. Main results: Among 1,201 patients who met the inclusion criteria, 35.9% (431/1,201) were treated successfully with HFNO and/or NIV and did not require IMV. About 59.5% (714/1,201) patients needed IMV for the failure of HFNO and/or NIV. About 48.3, 61.6, and 63.6% of patients who were treated with HFNO, NIV, or both, respectively, needed IMV. The need of IMV was significantly lower in the HFNO group (p <0.001). The 28-day mortality was 44.9, 59.9, and 59.6% in the patients treated with HFNO, NIV, or both, respectively (p <0.001). On multivariate regression analysis, presence of any comorbidity, SpO2 <90%, and presence of nonrespiratory organ dysfunction were independent and significant determinants of mortality (p <0.05). Conclusions: During COVID-19 pandemic surge, HFNO and/or NIV could successfully avoid IMV in 35.5% individuals with PO2/FiO2 ratio <150. Those who needed IMV due to failure of HFNO or NIV had high (87.5%) mortality.


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