Presión positiva en vía aérea y cánula de alto flujo en el tratamiento de insuficiencia respiratoria por COVID-19, en unidades de cuidados respiratorios especiales, de dos hospitales de referencia en la República de Panamá.

[Positive airway pressure and high-flow cannula in the treatment of respiratory failure due to COVID-19, in special respiratory care units, of two hospitals in the Republic of Panama]
DOI: 10.37980/im.journal.rmdp.20221892
Publicado
2022-08-30

Descargas

Archivos adicionales

Autores/as

  • Laura Saldana Staff Complejo Hospitalario Dr. Arnulfo Arias Madrid, CSS, Panamá, Panamá
  • Lorena Noriega Aguirre Complejo Hospitalario Dr. Arnulfo Arias Madrid, CSS, Panamá, Panamá
  • Ana Batista Hospital Dr. Rafael Hernandez, David, Chiriquí, Panamá
  • Juan Llerena Hospital Dr. Rafael Hernandez, David, Chiriquí, Panamá
  • Humberto Serrud Hospital Dr. Rafael Hernandez, David, Chiriquí, Panamá

Palabras clave:

COVID-19, oxígeno, cánula de alto flujo, ventilación mecánica no invasiva

Keywords:

COVID-19, oxigen, high-flow nasal cannula, non-invasive mechanic ventilation

Resumen

Introducción: En Panamá, así como en otras partes del mundo como España e Italia, se crearon Unidades de Cuidados Respiratorios Especiales para brindar soporte no invasivo a pacientes con insuficiencia respiratoria por neumonía por SARS-COV-2. En este trabajo se describen las características demográfica y clínicas de los pacientes que utilizaron ventilación no invasiva y/o cánula de alto flujo.  Material y métodos: El diseño del estudio fue prospectivo, observacional y descriptivo en dos hospitales de referencia en Panamá. Los pacientes firmaron un consentimiento informado y se procedió a llenar un cuestionario diario sobre las características demográficas y variables clínicas diarias.  Resultados: Se logró recolectar datos de 173 paciente, 60.69% correspondió al sexo masculino y se encontraban en una media de edad de 59 años, la comorbilidad más común fue la hipertensión arterial. El 88.75% de los pacientes tuvieron un NEWS 2 por arriba de 5 que indicaba mayor vigilancia por riesgo medio de paciente crítico, tanto la VMNI como el CAF tuvieron buenos resultados, 60% y 80% respectivamente. Conclusión: Nuestro estudio nos da luces sobre las características de los pacientes con insuficiencia respiratoria que requirieron dispositivos no invasivos y nos permite observar la evolución de estos en un contexto donde los recursos son limitados para terapia en cuidados intensivos.


Abstract

Introduction: In Panama, as in other parts of the world, Special Respiratory Care Units were created to provide non-invasive support to patients with respiratory failure due to SARS-COV-2 pneumonia. In this work, the demographic and clinical characteristics of the patients who used non-invasive ventilation and/or high-flow cannula are described. Material and method: The study design was prospective, observational and descriptive in two Reference Hospitals in Panama. The patients signed an informed consent and proceeded to fill out a daily questionnaire on demographic characteristics and daily clinical variables. Results: We included 173 patients, 60.69% were male and had a mean age of 59 years, and the most common comorbidity was hypertension. In the evaluation of the risks, the 88.75% had a NEWS 2 above 5 that indicated greater vigilance due to the medium risk of a critical patient, both NIV and HFC had good results in 60% and 80% respectively. Conclusion: Our study sheds light on the characteristics of patients with respiratory failure who required non-invasive devices and allows us to observe their evolution in a context where resources are limited for intensive care therapy.

Citas

REFERENCIAS

Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405-407. DOI: https://doi.org/10.1016/j.healun.2020.03.012

Tabary M, Khanmohammadi S, Araghi F, Dadkhahfar S, Tavangar SM. Pathologic features of COVID-19: A concise review. Pathol Res Pract. 2020;216(9):153097. DOI: https://doi.org/10.1016/j.prp.2020.153097

Li H, Liu L, Zhang D, Xu J, Dai H, Tang N, et al. SARS-CoV-2 and viral sepsis: observations and hypotheses. Lancet. 2020;395(10235):1517-1520. DOI: https://doi.org/10.1016/S0140-6736(20)30920-X

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. DOI: https://doi.org/10.1056/NEJMoa2001017

Lai CC, Wang CY, Wang YH, Hsueh SC, Ko WC, Hsueh PR. Global epidemiology of coronavirus disease 2019 (COVID-19): disease incidence, daily cumulative index, mortality, and their association with country healthcare resources and economic status. Int J Antimicrob Agents. 2020;55(4):105946. DOI: https://doi.org/10.1016/j.ijantimicag.2020.105946

Chang AY, Cullen MR, Harrington RA, Barry M. The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: a review. J Intern Med. 2021; 289(4):450-462. DOI: https://doi.org/10.1111/joim.13184

Dowd JB, Andriano L, Brazel DM, et al. Demographic science aids in understanding the spread and fatality rates of COVID-19. Proc Natl Acad Sci U S A. 2020;117(18):9696-9698. DOI: https://doi.org/10.1073/pnas.2004911117

Cinesi Gómez C, Peñuelas Rodríguez Ó, Luján Torné M, et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Med Intensiva (Engl Ed). 2020;44(7):429-438. DOI: https://doi.org/10.1016/j.medin.2020.03.005

Llamas M, Joaniquet S. Las UCRIS evitan ingresos en UCIS, disminuyen la mortalidad hospitalaria y ahorran costes a los hospitales | separ. https://www.separ.es/node/1806. 22 de abril de 2020

Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res. 2020;21(1):198. Published 2020 Jul 28. DOI: https://doi.org/10.1186/s12931-020-01462-5

Winslow RL, Zhou J, Windle EF, et al. SARS-CoV-2 environmental contamination from hospitalized patients with COVID-19 receiving aerosol-generating procedures. Thorax. 2022;77(3):259-267. DOI: https://doi.org/10.1136/thoraxjnl-2021-218035

National Early Warning Score (NEWS) 2. RCP London .Available from: www.rcplondon.ac.uk

Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47(3):375-384. DOI: https://doi.org/10.1086/589754

Artacho Ruiz R, Artacho Jurado B, Caballero Güeto F, et al. Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure. Predictores de éxito del tratamiento con cánula nasal de alto flujo en el fallo respiratorio agudo hipoxémico. Med Intensiva (Engl Ed). 2021;45(2):80-87. DOI: https://doi.org/10.1016/j.medin.2019.07.012

Guia MF, Boléo-Tomé JP, Imitazione P, et al. Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia. Respir Med. 2021; 187:106550. DOI: https://doi.org/10.1016/j.rmed.2021.106550

Ji D, Zhang D, Xu J, et al. Prediction for Progression Risk in Patients With COVID-19 Pneumonia: The CALL Score. Clin Infect Dis. 2020;71(6):1393-1399. DOI: https://doi.org/10.1093/cid/ciaa414

Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020;46(6):1099-1102. DOI: https://doi.org/10.1007/s00134-020-06033-2

Sykes DL, Crooks MG, Thu KT, Brown OI, Tyrer TJP, Rennardson J, et al. Outcomes and characteristics of COVID-19 patients treated with continuous positive airway pressure/high-flow nasal oxygen outside the intensive care setting. ERJ Open Research. 2021;7(4). DOI: https://doi.org/10.1183/23120541.00318-2021