ABSTRACT
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.
Subject(s)
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 & purificationABSTRACT
BACKGROUND: Obesity is associated with osteoarthritis and the need for joint surgery. Obese patients who undergo joint surgery may have a higher risk of morbidity compared with normal or overweight patients but less is known about their risk of postoperative disability. The primary objective of our study was to determine the association between obesity and the development of new dependence in activities of daily living within 2 years after joint surgery. METHODS: We obtained data from the Health and Retirement Study, a longitudinal survey of older Americans. We included participants who indicated having joint surgery for arthritis. We defined obesity as a BMI ≥30 kg m-2. Our outcome was a new or increased dependence in one or more activities of daily living after surgery. RESULTS: We analysed data on 2519 respondents who underwent joint surgery for arthritis. Respondents had a median age of 69yr, 65.5% were female, 66.6% had joint replacement surgery and 45.3% were obese. The overall incidence of a new dependence within 2years was 22.1%. Obese respondents had a higher incidence of new dependence compared with non-obese respondents (25.4% vs 19.4%, P<0.001). In adjusted analysis, obese respondents had increased odds of developing dependence [odds ratio 1.35 (95% CI 1.09-1.68), P=0.007]. CONCLUSIONS: Obesity is associated with an increased risk of developing dependence in the 2 years after joint surgery. Our study findings identify a high-risk group that may benefit from targeted interventions and allocation of perioperative resources to optimize recovery and minimize longer-term disability.
