RESUMEN
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19 that occurs in 20-41% of patients with severe disease. (7) SARS-CoV-2 patients present with a wide spectrum of clinical severity, ranging from asymptomatic to pneumonia to ARDS-like phenotypes. (8,9) During the early months of the COVID-19 pandemic unprecedented numbers of patients presented to hospitals with acute respiratory failure. With intensive care services at risk of being overwhelmed, strategies were soussght to reduce invasive mechanical ventilation (IMV). Whilst not previously a standard treatment for viral pneumonitis, early anecdotal accounts and preliminary data highlighted the use of continuous positive airway pressure (CPAP) in COVID-19. (7,10) Subsequently it gained traction as an intervention that could be delivered outside of the intensive therapy unit (ITU) and high-dependency unit (HDU) along with conservation of oxygen. Oxygen conservation posed a huge challenge in COVID ICU’s. HFNO being the major cause of oxygen consumption. Electrically driven CPAP machines • Use air to maintain Continuous positive airway pressure. • Decrease atelectasis. • Increase surface area of alveolus. • Improves V/Q matching. Thus, improving oxygenation and saving Oxygen with the use of electrically driven CPAP with oxygen supplement. CPAP has mostly been studied in relation to OSA and a lot is yet to be explored regarding its potential in COVID ICU’s. OBJECTIVES: I. To note the change in Spo2 II. To note if CPAP delivery system can reduce oxygen consumption as to HFNO III. To note if treatment is well tolerated IV. To note if use of CPAP can avoid/delay the use of HFNO/NIV METHOD: Patient’s vitals were noted before shifting to electrically driven CPAP machine and monitored throughout. Properly fitted vented Bi-pap mask was attached with the electrically driven CPAP machine and the oxygen was supplemented with the help of tubing connecting the Bi-pap mask vent to the flow-meter. The flow of oxygen was titrated according to patients requirements ranging from 8-12 liters/min.The pressure was set as per patients need and titrated as per the condition of the patient. During meal times the patients were shifted to HFNO. RESULT: Out of the total 30 patients in our study, 25 patients were successfully treated with the Electrically driven CPAP machine with O2 enrichment and did not require stepping up to further modalities of oxygen therapy. Around 1700 - 1900 L/hr of oxygen was being used by HFNO whereas only 600 - 720 L/hr of oxygen was used by use of CPAP which helped us to save about 29-80% of oxygen by the use of CPAP machine. CONCLUSION: From our limited study we can only conclude that the CPAP when used with Oxygen enrichment in COVID ICU’s can help in conservation of Oxygen by improving the respiratory mechanics of the COVID affected lung, which becomes an essential aim in a pandemic to serve maximum patients with limited resources.
RESUMEN
INTRODUCTION: The WHO, broadcasted COVID 19 as a public health emergency onJANUARY 30th ,2020 and subsequently declared a pandemic on MARCH 11th2020.Acute respiratory distress syndrome (ARDS) is a major complication of COVID-19that occurs in 20-41% of patients with severe disease.The pathophysiology of ARDS andCOVID-19 lung injury share many of the same aspects of reduced lung parenchymalcompliance, vasculopathy, alveolar flooding, and gas exchange impairment arising fromdirect infectious causes and noninfectious injuries.In patients with pneumonia,HFNOallows improved mobilisation of secretions,minimises oxygen dilution,meets inspiratorydemands and improve end-expiratory lung volumes.According to the present theories,prone positioning, by reducing ventral alveolar expansion and dorsal alveolar collapse,results in ventilation that is more homogeneous.OBJECTIVE: The goal of our study is to evaluate the reduction in consumption of oxygenby using proning as an adjunct to HFNO in patients of COVID 19 admitted in ICU.METHOD: This is an observational cross sectional type of study, which includes patientswho were hemodynamically stable and required HFNO to maintain oxygenation. Allpatients were counselled for the benefits of proning. Proning was done with the help ofnursing staff. All vitals were noted before proning and all throughout proning. We keptpatients in a prone position till patients were comfortable and duration of proning wasnoted. We titrated oxygen requirement (FIO2 and flow) to target spo2 level of 93-95%.RESULT: We studied in 26 patients on HFNO with proning, we found that proning helpsin 11-50% reduction in oxygen requirement to achieve target Spo2 level.The mean value ofoxygen consumption was 20833.27 L/HR with only use of HFNO which was more than15996.92 L/HR when patients were encouraged to be prone along with the use ofHFNO.The collected data was analysed and unpaired t test was applied after which p valueof 0.0154 was obtained, which is statistically significant.CONCLUSION: Based on this study it is concluded that there is significant reduction inconsumption of oxygen by using the prone position as an adjunct to HFNO in patients ofCOVID 19.