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COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems

BACKGROUND AND AIM: The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. METHODS: We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register o...

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Autores principales: Winck, J.C., Ambrosino, N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183996/
https://www.ncbi.nlm.nih.gov/pubmed/32362507
http://dx.doi.org/10.1016/j.pulmoe.2020.04.013
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author Winck, J.C.
Ambrosino, N.
author_facet Winck, J.C.
Ambrosino, N.
author_sort Winck, J.C.
collection PubMed
description BACKGROUND AND AIM: The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. METHODS: We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND: acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). RESULTS: Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200–300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100–200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1–2 h is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. CONCLUSION: Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.
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spelling pubmed-71839962020-04-27 COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems Winck, J.C. Ambrosino, N. Pulmonology Article BACKGROUND AND AIM: The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. METHODS: We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND: acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). RESULTS: Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200–300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100–200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1–2 h is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. CONCLUSION: Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure. Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. 2020 2020-04-27 /pmc/articles/PMC7183996/ /pubmed/32362507 http://dx.doi.org/10.1016/j.pulmoe.2020.04.013 Text en © 2020 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Winck, J.C.
Ambrosino, N.
COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
title COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
title_full COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
title_fullStr COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
title_full_unstemmed COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
title_short COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
title_sort covid-19 pandemic and non invasive respiratory management: every goliath needs a david. an evidence based evaluation of problems
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183996/
https://www.ncbi.nlm.nih.gov/pubmed/32362507
http://dx.doi.org/10.1016/j.pulmoe.2020.04.013
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