Review article
https://doi.org/10.21860/medflum2024_313682
Effectiveness and Complications of Non-Invasive Respiratory Support, Especially Treatment with Continuous Positive Airway Pressure in COVID-19 Patients
Nikica Karković
orcid.org/0000-0003-3234-8784
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Ivan Šitum
orcid.org/0000-0002-4113-2400
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Daniel Lovrić
; KBC Zagreb, Klinika za bolesti srca i krvnih žila, Zagreb, Hrvatska
Ante Erceg
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Gloria Mamić
orcid.org/0000-0001-6505-3021
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Nikolina Džaja
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Dragan Mihaljević
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Dora Karmelić
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Romana Perković
; KBC Zagreb, Klinika za neurologiju, Zagreb, Hrvatska
Slobodan Mihaljević
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Mirabel Mažar
orcid.org/0000-0002-4589-2490
; KBC Zagreb, Klinika za anesteziologiju, reanimatologiju, intenzivno liječenje i terapiju boli, Zagreb, Hrvatska
Abstract
At the beginning of the COVID-19 pandemic, healthcare systems suffered tremendous pressure due to the large influx of COVID-19 patients. The additional burden was contributed by the shortage of healthcare personnel and the threatening shortage of ventilators. High mortality of patients on invasive respiratory support was also recorded. For these reasons, a discussion has been initiated about the increased use of non-invasive respiratory support (NIRS), which includes high-flow oxygen delivered through nasal cannula (HFNC), the use of continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). Unfortunately, there are no standardized guidelines for selecting patients for a particular modality of non-invasive respiratory support, and the effectiveness of NIRS is still the subject of numerous debates and researches. The results of previous studies suggest that NIRS can improve oxygenation and reduce the need for invasive mechanical ventilation and the risk of death in COVID-19 patients. However, the effectiveness and comparisons of individual modalities of non-invasive respiratory support have been investigated in only a few studies. Recent studies indicate the superiority of CPAP compared to NIV and HFNC, but the results should be interpreted with caution since the most of the previous studies on the use of non-invasive ventilation modalities in COVID-19 patients have significant limitations and shortcomings. During non-invasive respiratory support, it is necessary to carefully monitor the patient's clinical condition with periodic analysis of gases in the arterial blood and evaluation of the HACOR score (heart rate, acidosis, consciousness, oxygenation, respiratry rate). It is necessary to recognize and react to possible complications of non-invasive respiratory support in time. Although the rate of pulmonary barotrauma during non-invasive respiratory support has so far been considered negligibly low, the research in COVID-19 patients has shown a much higher incidence, which, based on previous research, is attributed to the specific pathophysiology of the SARS-CoV-2 virus. Declaring non-invasive respiratory support unsuccessful is based on the clinical judgment, and should be individualized for each patient and recognized in time, as delay in intubation and invasive ventilation have been shown as independent risk factors for the development of pulmonary complications and a worse outcome.
Keywords
Barotrauma; Continuous Positive Airway Pressure; COVID-19; Noninvasive Ventilation
Hrčak ID:
313682
URI
Publication date:
1.3.2024.
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