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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
  1. Graham P Burns1,2,
  2. Nicholas D Lane1,2,
  3. Hilary M Tedd1,
  4. Elizabeth Deutsch1,
  5. Florence Douglas1,
  6. Sophie D West1,2,
  7. Jim G Macfarlane1,
  8. Sarah Wiscombe1 and
  9. Wendy Funston1
  1. 1Department of Respiratory Medicine, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
  2. 2Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr Graham P Burns; graham.burns2{at}nhs.net

Abstract

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.

  • non invasive ventilation
  • respiratory infection
  • viral infection
  • lung physiology
  • assisted ventilation
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • GPB and NDL are joint first authors.

  • Contributors GPB conceived and designed the study and drafted the initial manuscript. All authors obtained patient data. GPB and NDL performed statistical analysis, and all authors undertook review and interpretation of the data. The manuscript was revised and the final version was approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GPB is the president elect of the British Thoracic Society.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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