ABSTRACT
Background: During Covid-19 pandemic, several patients (pts) suffering from ARDS underwent tracheostomy. Decannulation was managed in different step-down units and no standardized procedures are available. Aim(s): To compare time of decannulation and clinical management of tracheostomized pts for Covid-19 ARDS in rehabilitation (R) vs respiratory wards (RW). Method(s): This retrospective, multicenter study compared tracheostomized pts for Covid-19 ARDS, admitted to RW (51 pts) and R (45 pts) from March 2020 to May 2021. Demographic and clinical data, duration of tracheostomy and standard of care in both settings were collected. Result(s): No differences were showed in demographic and clinical data, except the prevalence of Invasive Ventilation (IV): 59% pts in RW vs 38% pts in R (p=0.04). All pts were weaned from IV;time of weaning did not differ in the two wards (median days: 0 [IQR: 0-6.5] in R vs 1 [IQR: 0-7] in RW;p=0.17). In both settings, more than 90% of pts were decannulated and decannulation time was not different (median days: 13 [IQR: 7.5-18.5] in R vs 14 [IQR: 9-17.5] in RW;p=0.67). High flow therapy was more used in R (69% vs 47% pts in RW;p=0.03). The assessment of swallowing was performed in 93% pts in R vs 63% pts in RW (p<0.01). Dysphagia was showed in 43% vs 37% of screened pts in R e RW respectively (p=0.08). The physiotherapy (FT) was carried out in 100% pts in R vs 84% pts in RW (p=0.17). Conclusion(s): The setting of care does not affect time or success of decannulation in Covid-19 tracheostomized pts, probably thanks to FT implementation in both wards. High prevalence of dysphagia was detect indicating the need for swallowing screening and speech therapy.
ABSTRACT
Background: Tracheotomy is a routine procedure for patients requiring prolonged mechanical ventilation (MV) in intensive care units (ICUs), included Covid-19 ARDS, for which few data about decannulation are available. Aim(s): To compare time to decannulation between Covid-19 and no-Covid-19 ARDS and identify possible predictive factors. Method(s): In this retrospective, multicenter study, 96 tracheotomized patients, admitted from March 2020 to May 2021 in 5 pulmonary wards after an ICU stay due to Covid-19 ARDS, are compared to 32 tracheotomized ARDS patients not associated to Covid-19 admitted before its outbreak. Clinical, demographic data and comorbidities are analyzed. Result(s): Median age is lower in Covid-19 group;sex prevalence, body mass index (BMI) and frailty do not differ between the two groups as well as timing of decannulation (median days: 14 [IQR 9-22] vs 13 [IQR 8-18] in noCovid-19 and Covid-19 ARDS, respectively;p=0.08). In a multivariate linear regression analysis, Medical Research Council (MRC) scale (beta -0.33;p<0.0001), duration of steroids (beta 0.28;p=0.001), clinical complications (beta 0.27;p=0.004), PaO2/FiO2 ratio (beta -0.25;p=0.007) and history of smoke (beta 0.18;p=0.04) significantly predict timing of decannulation in both groups. Conclusion(s): Timing of decannulation in Covid-19 ARDS patients is not different from no-Covid-19 ARDS. In Covid19 patients, past knowledge about decannulation and the need of relieve post-ICU setting avoid the delay in decannulation time if compared to no-Covid-19 patients. ICU-acquired weakness, evaluated by MRC scale, seems to be a strong predictor of longer time to decannulation in the two groups.
ABSTRACT
Background: Since February 2020, CoViD-19 spread in Italy. Acute respiratory failure (ARF) was the most relevant clinical presentation, often requiring invasive and non-invasive ventilation. We report the management of ARF in in-patients using Easy Vent Mask (EVM) system for C-PAP, a device registered for prehospital use. Methods: In this retrospective study, we included all patients admitted to Emergency Medicine Unit from March 2 to April 25, 2020 with ARF secondary to CoViD-19 pneumonia and treated with EVM system. Our aim was to evaluate the efficacy and tolerability of in-hospital use of EVM system. All demographic, clinical and treatment data were recorded. Results: Thirty patients affected by mild/moderate CoViD-19 pneumonia having PaO2/FiO2(P/F) ratio between 100 and 200 were treated with EVM system for C-PAP, of them 25(83%) were discharged and 5(17%) died in hospital. The system was well tolerated with a mean time of use of 13 consecutive days. Five patients were transferred to ICU due to failure of C-PAP treatment, of whom 3 died. Two patients died in our ward for worsening of clinical conditions. Pressure skin lesions and hypercapnia were recorded as adverse events in 24 and 2 patients respectively. Moreover, our finding showed a higher reduction of P/F value and a longer time from admission to C-PAP initiation in non-survivors, compared to survivor patients. Conclusions: EVM system for C-PAP seemed to be well tolerated and may represent an alternative to ventilators in in-hospital treatment of CoViD-19 mild/moderate pneumonia, but dedicated studies are needed.