Репозиторий Университета

© 2020 Elsevier Inc. Aim: Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF). We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. Materials & methods: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay. Results: Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO2, D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period. Conclusions: NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

© 2020 Elsevier Inc. Aim: Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF). We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. Materials & methods: In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay. Results: Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO2, D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period. Conclusions: NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

© 2018 Medical Education. All rights reserved. The aim of the study was to investigate an efficacy of short-term treatment with acetazolamide (ACET) in patients with acute exacerbation of COPD (AECOPD) and noninvasive ventilation (NIV). Methods. This was a prospective case-control study. The study involved 20 patients. Inclusion criteria were as follows: AECOPD; pH > 7.33; PaCO2 > 48 mmHg; HCO3 - > 26 mmol/L; and treatment with NIV. Clinical characteristics, Charlson comorbidity index, APACHE II score, arterial blood gases, and serum electrolytes were recorded before inclusion. Patients were defined as cases when they had received ACET (500 mg per day) for 3 days; they were compared to a matched control group who did not receive ACET. Clinical parameters, arterial blood gases, serum electrolytes, potential adverse effects, and length of hospital stay were monitored daily. Results. No significant differences in baseline characteristics, comorbidities, or concomitant drugs used were found between the groups. Mean duration of hospital stay was significantly shorter in the ACET group (16.2 ± 8.4 days vs 19.1 ± 2.8 days; p = 0.023). An iIntra-group analysis showed a significant improvement in clinical and arterial blood gas parameters in both groups already in the first day of the treatment. In the ACET group, systolic blood pressure (SBP), respiratory rate (RR), and SpO2 significantly improved at day 4 (112.5 ± 4.9 mmHg vs 125 ± 7.1 mmHg (p = 0.001); 15.2 ± 1.1 min-1 vs 17.1 ± 0.9 min-1 (p = 0.001) and 94.7 ± 1.1% vs 92.3 ± 0.8% (p = 0.0001), respectively). There was a significant decrease in PaCO2, pH and HCO3- at day 3 (48 ± 3.8 mmHg vs 52.4 ± 5.3 mmHg (p = 0.0288); 7.374 ± 0.4 vs 7.502 ± 0.17 (p = 0.0015) and 26.4 ± 2.8 mmol/L vs 36.9 ± 4.1 mmol/L (p = 0.00001), respectively) and day 4 (44 ± 2.4 mmHg vs 48.4 ± 4.6 mmHg (p = 0.0115); 7.387 ± 0.02 vs 7.480 ± 0.02 (p = 0.00001) and 24.2 ± 2.1 mmol/L vs 35.6 ± 3.0 mmol/L (p = 0.00001), respectively) in the ACET group. No adverse events were recorded in both groups. Conclusions. ACET adjuvant to NIV appears to be effective and could prevent post-NIV alkalosis occurrence and could reduce the length of hospital stay in patients with AECOPD and mixed metabolic disorders (respiratory acidosis and metabolic alkalosis).