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Pulmonology ; 27(5): 413-422, 2021.
Article in English | MEDLINE | ID: covidwho-1057245


Helmet CPAP (H-CPAP) has been recommended in many guidelines as a noninvasive respiratory support during COVID-19 pandemic in many countries around the world. It has the least amount of particle dispersion and air contamination among all noninvasive devices and may mitigate the ICU bed shortage during a COVID surge as well as a decreased need for intubation/mechanical ventilation. It can be attached to many oxygen delivery sources. The MaxVenturi setup is preferred as it allows for natural humidification, low noise burden, and easy transition to HFNC during breaks and it is the recommended transport set-up. The patients can safely be proned with the helmet. It can also be used to wean the patients from invasive mechanical ventilation. Our article reviews in depth the pathophysiology of COVID-19 ARDS, provides rationale of using H-CPAP, suggests a respiratory failure algorithm, guides through its setup and discusses the issues and concerns around using it.

COVID-19/therapy , Continuous Positive Airway Pressure/instrumentation , Noninvasive Ventilation/instrumentation , Respiratory Insufficiency/therapy , Ventilator Weaning/methods , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/transmission , Head Protective Devices , Humans , Noninvasive Ventilation/methods , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/nursing , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
Intensive Crit Care Nurs ; 62: 102967, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-915466


INTRODUCTION: The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload. OBJECTIVE: To assess the nurse-patient ratio required by COVID-19 patients and to identify the factors that influence nursing in this context. DESIGN: This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS). SETTING: Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients. MEASUREMENTS AND MAIN RESULTS: The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6-6.4). CONCLUSIONS: Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.

COVID-19/nursing , Critical Care Nursing , Postoperative Care/nursing , Respiratory Insufficiency/nursing , Sepsis/nursing , Shock, Cardiogenic/nursing , Workload , APACHE , Age Factors , Aged , Aged, 80 and over , Belgium , Continuous Renal Replacement Therapy/nursing , Female , Humans , Hygiene , Intensive Care Units , Male , Middle Aged , Mortality , Moving and Lifting Patients/nursing , Nurses , Nursing Care/statistics & numerical data , Patient Positioning/nursing , Respiration, Artificial/nursing , Retrospective Studies , SARS-CoV-2 , Time Factors