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Improved survival following ward-based non-invasive pressure support for severe hypoxia in a cohort of frail patients with COVID-19: retrospective analysis from a UK teaching hospital

Lookup NU author(s): Dr Graham Burns, Dr Nicholas Lane, Dr Hilary Tedd, Dr Jim Macfarlane, Dr Sarah Wiscombe, Dr Wendy Funston

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.Since the outbreak of COVID-19 in China in December 2019, a pandemic has rapidly developed on a scale that has overwhelmed health services in a number of countries. COVID-19 has the potential to lead to severe hypoxia; this is usually the cause of death if it occurs. In a substantial number of patients, adequate arterial oxygenation cannot be achieved with supplementary oxygen therapy alone. To date, there has been no clear guideline endorsement of ward-based non-invasive pressure support (NIPS) for severely hypoxic patients who are deemed unlikely to benefit from invasive ventilation. We established a ward-based NIPS service for COVID-19 PCR-positive patients, with severe hypoxia, and in whom escalation to critical care for invasive ventilation was not deemed appropriate. A retrospective analysis of survival in these patients was undertaken. Twenty-eight patients were included. Ward-based NIPS for severe hypoxia was associated with a 50% survival in this cohort. This compares favourably with Intensive Care National Audit and Research Centre survival data following invasive ventilation in a less frail, less comorbid and younger population. These results suggest that ward-based NIPS should be considered as a treatment option in an integrated escalation strategy in all units managing respiratory failure secondary to COVID-19.

Publication metadata

Author(s): Burns GP, Lane ND, Tedd HM, Deutsch E, Douglas F, West SD, Macfarlane JG, Wiscombe S, Funston W

Publication type: Review

Publication status: Published

Journal: BMJ Open Respiratory Research

Year: 2020

Volume: 7

Issue: 1

Online publication date: 05/07/2020

Acceptance date: 23/06/2020

ISSN (electronic): 2052-4439

Publisher: NLM (Medline)

URL: https://doi.org/10.1136/bmjresp-2020-000621

DOI: 10.1136/bmjresp-2020-000621

PubMed id: 32624494

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