DOI: 10.29245/2689-999X/2021/2.1176 View / Download Pdf
Fatima Mahmood1*, Moiz Ehtesham1, Syed Muhammad Mashhood Ali Bokhari2, Ruben A. Peredo-Wende3
1Department of Internal Medicine, Albany Medical College, Albany, NY, USA
2University of Texas Southwestern Medical Center, Dallas, TX, USA
3Rheumatology Stratton Veteran Medical Center, Albany, NY, USA
DOI: 10.29245/2689-999X/2021/2.1175 View / Download Pdf
Moiz Ehtesham1*, Fatima Mahmood2, Muhammad Asim Shabbir1, Ruben-Wende Peredo1
1Department of Internal Medicine, Division of Rheumatology, Albany Medical College, Albany, NY, USA
2Department of Medicine, Albany Medical College, Albany, NY, USA
Treatment with Non-invasive respiratory support in severe COVID-19: Clinical effectiveness observational study
Gonzalo Segrelles-Calvo1*, Estefanía Llopis-Pastor1, Glauber Ribeiro de Sousa Araújo2, Inés Escribano1, Esther Antón1, Laura Rey1, Nestor Rodriguez Melean1, Marta Hernández1, Javier Carrillo1, Celia Zamarro1, Mercedes García-Salmones1, Susana Frases2.
1Respiratory Intermediate Care Unit, Respiratory Department, University Rey Juan Carlos Hospital, Madrid, Spain
2Laboratorio de Biofísica de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Brasil
Introduction: The study aimed to analyse the clinical response and short-term outcomes with the use of high-flow oxygen therapy (HFOT), non-invasive mechanical ventilation (NIMV) with bilevel positive airway pressure, or continuous positive airway pressure (CPAP) in severe COVID-19 patients.
Methods: We conducted an observational, prospective, single-center study, approved by Ethics Committee of “Instituto de Investigación Sanitaria Fundación Jiménez Díaz” (EO102-20-HRJC).
We included a total of 130 patients ≥18 years-old, with proved SARS-CoV-2 infection and secondary Acute Respiratory Failure (ARF) that required treatment with Non-invasive Respiratory Support (NIRS). We collected data about population demographic characteristics, clinical factors, and evolution during the incoming. A baseline of patients treated with HFO, CPAP and NIMV were compared with one-way ANOVA test, while categorical variables were expressed as numbers and percentages and were compared using the chi-square test or Fisher’s exact test when appropriate.
Results: The cohort was distributed as follows: CPAP 54.6% (n = 71), NIMV 30% (n = 39), HFO 15.4% (n = 20). There were no differences between NIRS subgroups regarding age, comorbidity, or functional status. At the beginning of NIRS treatment, PaO2/FiO2 value was 149.3 ± 69.7. After 24 hours, PaO2/FiO2 was significantly higher in the CPAP group (CPAPvsNIMV, p-value = 0.0042; CPAPvsHFO, p-value = 0.000169).
The overall ICU admission evaded rate was 69.1% and TF rate was 43.8%, without differences between the three therapies (p-value = 0.281). The mortality rate was 37.2%, without significant differences between subgroups.
Conclusions: Our data suggest that CPAP versus treatment with NIMV or HFO improves PaO2/FiO2 rate in severe ARF patients, significantly reducing ICU admission. No differences were observed in mortality or therapeutic failure.DOI: 10.29245/2689-999X/2021/2.1173 View / Download Pdf
Dewansh Goel, MD, MPH*, Kenneth Iyamu, MD, FACP
University of Central Florida/HCA GME Consortium, Ocala Regional Medical Center, Florida, USA
Usage of vaping and electronic cigarettes products is a growing trend among young adults, with rising rates worldwide. Such products are gaining popularity for many reasons including an alternative to smoking cigarettes, trying something new, or as a means to relax. While users may feel that these products are less harmful or a safer substitute to smoking traditional products, the side effect profile of vape inhalation has the potential for profound injury to the lung tissue and significant respiratory failure. We would like to present a case in which a young male who was evaluated at our Emergency department for acute onset respiratory failure subsequently requiring invasive mechanical ventilation in the setting of vaping associated lung injury (VALI). In the case report, we will highlight the patient’s clinical course as well as a summary of the current evidence surrounding evaluation, diagnosis and management of this emerging pathology. We want to emphasize the importance of a detailed history which should include the use of vaping products when a young patient presents with acute respiratory failure, allowing VALI to be in the differential diagnosis. Additionally, we want to compare the clinical presentation of VALI to that of COVID-19 pneumonia as they both have many similar attributes including symptoms and findings on lung imaging studies.DOI: 10.29245/2689-999X/2021/2.1170 View / Download Pdf