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The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients
BACKGROUND: During the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397873/ https://www.ncbi.nlm.nih.gov/pubmed/34454416 http://dx.doi.org/10.1186/s12873-021-00491-7 |
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author | Ruangsomboon, Onlak Boonmee, Phetsinee Nimmannit, Akarin |
author_facet | Ruangsomboon, Onlak Boonmee, Phetsinee Nimmannit, Akarin |
author_sort | Ruangsomboon, Onlak |
collection | PubMed |
description | BACKGROUND: During the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have also occurred to other non-COVID-infected patients in the Emergency Department (ED). METHODS: A retrospective analytic study was conducted in the ED of Siriraj Hospital, Bangkok, Thailand, including adult patients presenting with signs and symptoms of respiratory distress between 1 March and 30 April 2020 (the COVID period). A comparison group using the same inclusion criteria was retrieved from 1 March to 30 April 2019 (the pre-COVID period). The primary outcome was rate of NIV and HFNC use. The secondary outcomes were rate of intubation, failure of NIV and HFNC, complications, and mortality. RESULTS: A total of 360 and 333 patients were included during the pre-COVID and COVID periods, respectively. After adjusting for baseline differences, patients in the COVID period were less likely to receive either NIV or HFNC than the pre-COVID period (adjusted OR 0.52 [95%CI 0.29–0.92]). Overall, intubation rate was similar between the two study periods. However, patients in respiratory distress with pulmonary edema had a relatively higher intubation rate in the COVID period. There were higher failure rates of NIV and HFNC, more infectious complications, and a higher rate of mortality in the pre-COVID period. CONCLUSION: During the COVID-19 pandemic, the overall usage of NIV and HFNC in emergency non-COVID patients decreased. Although not affecting the overall intubation rate, this change of practice could have affected some groups of patients. Therefore, treatment decisions based on a balance between the benefits to the patients and the safety of healthcare providers should be made. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12873-021-00491-7. |
format | Online Article Text |
id | pubmed-8397873 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-83978732021-08-30 The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients Ruangsomboon, Onlak Boonmee, Phetsinee Nimmannit, Akarin BMC Emerg Med Research BACKGROUND: During the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have also occurred to other non-COVID-infected patients in the Emergency Department (ED). METHODS: A retrospective analytic study was conducted in the ED of Siriraj Hospital, Bangkok, Thailand, including adult patients presenting with signs and symptoms of respiratory distress between 1 March and 30 April 2020 (the COVID period). A comparison group using the same inclusion criteria was retrieved from 1 March to 30 April 2019 (the pre-COVID period). The primary outcome was rate of NIV and HFNC use. The secondary outcomes were rate of intubation, failure of NIV and HFNC, complications, and mortality. RESULTS: A total of 360 and 333 patients were included during the pre-COVID and COVID periods, respectively. After adjusting for baseline differences, patients in the COVID period were less likely to receive either NIV or HFNC than the pre-COVID period (adjusted OR 0.52 [95%CI 0.29–0.92]). Overall, intubation rate was similar between the two study periods. However, patients in respiratory distress with pulmonary edema had a relatively higher intubation rate in the COVID period. There were higher failure rates of NIV and HFNC, more infectious complications, and a higher rate of mortality in the pre-COVID period. CONCLUSION: During the COVID-19 pandemic, the overall usage of NIV and HFNC in emergency non-COVID patients decreased. Although not affecting the overall intubation rate, this change of practice could have affected some groups of patients. Therefore, treatment decisions based on a balance between the benefits to the patients and the safety of healthcare providers should be made. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12873-021-00491-7. BioMed Central 2021-08-28 /pmc/articles/PMC8397873/ /pubmed/34454416 http://dx.doi.org/10.1186/s12873-021-00491-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Ruangsomboon, Onlak Boonmee, Phetsinee Nimmannit, Akarin The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients |
title | The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients |
title_full | The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients |
title_fullStr | The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients |
title_full_unstemmed | The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients |
title_short | The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients |
title_sort | covid-19 pandemic: the effect on airway management in non-covid emergency patients |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397873/ https://www.ncbi.nlm.nih.gov/pubmed/34454416 http://dx.doi.org/10.1186/s12873-021-00491-7 |
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