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1. The PANDORA Study: Prevalence and Outcome of Acute Hypoxemic Respiratory Failure in the Pre-COVID-19 Era

Author

Jesús Villar, MD, PhD, FCCM, Juan M. Mora-Ordoñez, MD, Juan A. Soler, MD, PhD, Fernando Mosteiro, MD, PhD, Anxela Vidal, MD, Alfonso Ambrós, MD, PhD, Lorena Fernández, MD, Isabel Murcia, MD, Belén Civantos, MD, Miguel A. Romera, MD, Adrián Mira, MD, Francisco J. Díaz-Domínguez, MD, Dácil Parrilla, MD, J. Francisco Martínez-Carmona, MD, Domingo Martínez, MD, Lidia Pita-García, MD, Denis Robaglia, MD, Ana Bueno-González, MD, Jesús Sánchez-Ballesteros, MD, Ángel E. Pereyra, MD, Mónica Hernández, MD, Carlos Chamorro-Jambrina, MD, Pilar Cobeta, MD, Raúl I. González-Luengo, MD, Raquel Montiel, MD, Leonor Nogales, MD, M. Mar Fernández, MD, PhD, Blanca Arocas, MD, Álvaro Valverde-Montoro, MD, Ana M. del Saz-Ortiz, MD, Victoria Olea-Jiménez, MD, José M. Añón, MD, PhD, Pedro Rodríguez-Suárez, MD, Rosa L. Fernández, MSc, Cristina Fernández, MSc, Tamas Szakmany, MD, PhD, Jesús M. González-Martín, PhD, Carlos Ferrando, MD, PhD, Robert M. Kacmarek, PhD, RTT, Arthur S. Slutsky, MD, for the Prevalence AND Outcome of acute hypoxemic Respiratory fAilure (PANDORA) Network, José M. Añón, Belén Civantos, Mónica Hernández, Elena González, Rosario Solano, F. Javier Díaz-Domínguez, Demetrio Carriedo, Raul I. González Luengo, Carlos Ferrando, Blanca Arocas, Javier Belda, Marina Soro, Gerardo Aguilar, Ernesto Pastor, Lorena Fernández, Jesús Sánchez-Ballesteros, Arturo Muriel, Pablo Blanco-Schweizer, José Ángel de Ayala, Jesús Blanco, César Aldecoa, Alba Pérez, Jesús Rico-Feijoo, Leonor Nogales, David Andaluz, Laura Parra, Juan A. Soler, Domingo Martínez, Ana M. del Saz-Ortiz, Alfonso Ambrós, Ana Bueno-González, Carmen Hornos-López, Raquel Montiel, Dácil Parrilla, Eduardo Peinado, Isidro Prieto, Mario Chico, Miguel A. Romera, Carlos Chamorro-Jambrina, Juan M. Mora-Ordoñez, J. Francisco Martínez-Carmona, Álvaro Valverde-Montoro, Victoria Olea-Jiménez, Paco Alba, Ruth Corpas, Fernando Mosteiro, Lidia Pita-García, Eleuterio Merayo, Chanel Martínez, Ángeles de Célis-Álvarez, Carmen Martín-Delgado, Adrián Mira, Pilar Cobeta, David Pestaña, María del Mar Fernández, Concepción Tarancón, Silvia Cortés-Díaz, Anxela Vidal, Denis Robaglia, César Pérez, Isabel Murcia, Ángel E. Pereyra-Pache, Tamas Szakmany, Jesús Villar, Rosa L. Fernández, Cristina Fernández, Pedro Rodríguez-Pérez, Jesús M. González-Martín, Robert M. Kacmarek, and Arthur S. Slutsky

Subjects
Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

OBJECTIVES:. To establish the epidemiological characteristics, ventilator management, and outcomes in patients with acute hypoxemic respiratory failure (AHRF), with or without acute respiratory distress syndrome (ARDS), in the era of lung-protective mechanical ventilation (MV). DESIGN:. A 6-month prospective, epidemiological, observational study. SETTING:. A network of 22 multidisciplinary ICUs in Spain. PATIENTS:. Consecutive mechanically ventilated patients with AHRF (defined as Pao2/Fio2 ≤ 300 mm Hg on positive end-expiratory pressure [PEEP] ≥ 5 cm H2O and Fio2 ≥ 0.3) and followed-up until hospital discharge. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Primary outcomes were prevalence of AHRF and ICU mortality. Secondary outcomes included prevalence of ARDS, ventilatory management, and use of adjunctive therapies. During the study period, 9,803 patients were admitted: 4,456 (45.5%) received MV, 1,271 (13%) met AHRF criteria (1,241 were included into the study: 333 [26.8%] met Berlin ARDS criteria and 908 [73.2%] did not). At baseline, tidal volume was 6.9 ± 1.1 mL/kg predicted body weight, PEEP 8.4 ± 3.1 cm H2O, Fio2 0.63 ± 0.22, and plateau pressure 21.5 ± 5.4 cm H2O. ARDS patients received higher Fio2 and PEEP than non-ARDS (0.75 ± 0.22 vs 0.59 ± 0.20 cm H2O and 10.3 ± 3.4 vs 7.7 ± 2.6 cm H2O, respectively [p < 0.0001]). Adjunctive therapies were rarely used in non-ARDS patients. Patients without ARDS had higher ventilator-free days than ARDS (12.2 ± 11.6 vs 9.3 ± 9.7 d; p < 0.001). All-cause ICU mortality was similar in AHRF with or without ARDS (34.8% [95% CI, 29.7–40.2] vs 35.5% [95% CI, 32.3–38.7]; p = 0.837). CONCLUSIONS:. AHRF without ARDS is a very common syndrome in the ICU with a high mortality that requires specific studies into its epidemiology and ventilatory management. We found that the prevalence of ARDS was much lower than reported in recent observational studies.

Published
2022
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3. Non-invasive respiratory support in the management of COVID-19: Report of a series using a nasal CPAP mask

Author

Adrián Mira Betancur and Angélica De Pablo Pajares

Subjects
Adult, medicine.medical_specialty, Respiratory Airflow, medicine.medical_treatment, Severe Acute Respiratory Syndrome, Critical Care and Intensive Care Medicine, Article, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Medicine, Intubation, Respiratory system, Respiratory Distress Syndrome, Noninvasive Ventilation, Respiratory distress, business.industry, Medical record, 030208 emergency & critical care medicine, medicine.disease, Comorbidity, Coronavirus, Distress, Anesthesiology and Pain Medicine, Respiratory failure, Emergency medicine, Breathing, Respiratory Insufficiency, business
Abstract

Background During peak pandemic period of COVID-19, our hospital required rapid reorganization of resources and staff during between mid-March and early April 2020. Within this interval, the hospital responded to an overwhelming rate of admissions of patients in respiratory failure, rapidly reaching over 95% of its usual inpatient bed capacity and requiring 70 extra critical care beds and at least 40 intermediate care unit beds. This created a significant shortage of materials including ventilation equipment, requiring improvised use of available resources. Aims To describe our use of non-invasive ventilation (NIV) with the continuous positive nasal airway pressure (CPAP) device SuperNO2VA™ (Vyaire Medical, Mettawa, IL) with hospitalized patients in acute respiratory failure due to presumed COVID-19. Methods We performed a retrospective analysis of 14 inpatients receiving NIV CPAP at the Hospital Ramon y Cajal in Madrid, Spain. These were inpatients presenting in respiratory failure during the peak pandemic period based on defined respiratory health, oxygenation, and comorbidity status criteria. Patient data were retrospectively acquired from patient medical records. Results All 14 patients were reviewed. Our series consisted of 11 males and three females with an average age of 61.5 years. Ten of 14 patients (71.4%) NIV CPAP patients did not require intubation or reintubation. Of the four unsuccessful cases, one required intubation, two required reintubation, and one expired. Conclusions In a time of crisis, anesthesiologists and respiratory specialists implemented the use of NIV CPAP with SuperNO2VA to help meet the high care demand of patients in respiratory distress. Although the SuperNO2VA was not originally developed for the management of patients in respiratory failure or distress related to COVID-19, this case series demonstrates it can be used with mostly favorable results during a time of limited resources to improve the clinical situation in patients. Advantages and disadvantages are explored.

Published
2021

4. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS

Author

Ferrando, Carlos, Suarez-Sipmann, Fernando, Mellado-Artigas, Ricard, Hernández, María, Gea, Alfredo, Arruti, Egoitz, Aldecoa, César, Martínez-Pallí, Graciela, Martínez-González, Miguel A., Slutsky, Arthur S., Villar, Jesús, Graciela, Martínez-Pallí, Mercadal, Jordi, Muñoz, Guido, Mellado, Ricard, Jacas, Adriana, Vendrell, Marina, Sánchez-Etayo, Gerard, Alcón, Amalia, Belda, Isabel, Agustí, Mercé, Carramiñana, Albert, Gracia, Isabel, Panzeri, Miriam, León, Irene, Balust, Jaume, Navarro, Ricard, Arguís, María José, Carretero, Maria José, Ibáñez, Cristina, Perdomo, Juan, López, Antonio, López, Manuel, Cuñat, Tomás, Ubré, Marta, Ojeda, Antonio, Calvo, Andrea, Rivas, Eva, Hurtado, Paola, Pujol, Roger, Martín, Nuria, Tercero, Javier, Sanahuja, Pepe, Magaldi, Marta, Coca, Miquel, del Rio, Elena, Martínez-Ocon, Julia, Masgoret, Paula, Caballero, Angel, Risco, Raquel, Gómez, Lidia, de Riva, Nicolás, Ruiz, Ana, Beatriz, Tena, Jaramillo, Sebastián, Balibrea, Jose María, de Lacy, Francisco Borja, Otero, Ana, Ibarzabal, Ainitze, Bravo, Raquel, Carreras, Anna, Martín-Barreda, Daniel, Alias, Alfonso Jesús, Balaguer, Mariano, Aliaga, Jorge, Almuedo, Alex, Alonso, Joan Ramón, Andrea, Rut, Angelès, Gerard Sergi, Arias, Marilyn, Aziz, Fátima, Badía, Joan Ramon, Barbeta, Enric, Torres, Toni, Batiste, Guillem, Benet, Pau, Borrat, Xavi, Borrell, María, Bragulat, Ernest, Carmona, Inmaculada, Castellà, Manuel, Castro, Pedro, Ceravalls, Joan, Comino, Oscar, Cucciniello, Claudia, De Deray, Clàudia, De Diego, Oriol, De la Matta, Paula, Farrero, Marta, Fernández, Javier, Fernández, Sara, Fernández, Anna, Ferrer, Miquel, Fervienza, Ana, Forga, María Tallo, Forné, Daniel, Galán, Clàudia, Gomez, Andrea, Guasch, Eduard, Tejero, Maria Hernández, Jiménez, Beltrán, Leyes, Pere, López, Teresa, Martínez, José Antonio, Muñoz, Jose, Nicolás, Josep Maria, Ortiz, José Tomás, Peiró, Anna, Pérez, Manuel, Poch, Esteban, Pujol, Margarida, Quintana, Eduard, Ramis, Bartomeu, Reverter, Enric, Rovira, Irene, Ruiz, Pablo, Sandoval, Elena, Schneider, Stefan, Sibila, Oriol, Solé, Carla, Soriano, Alex, Soy, Dolors, Suárez, M., Téllez, Adrián, Toapanta, Néstor David, Torres, Antoni, Urra, Xavier, Bordell, Alicia, Martín, Silvia, Andrés, Judith, Ruiz, Alberto Martínez, Medel, Gonzalo Tamayo, Villasante, Iñaki Bilbao, Clavero, Fernando Iturri, Álvarez, Covadonga Peralta, Herrera, Julia T., Trancho, Andrea García, Mandiola, Iñaki Sainz, Suarez, Carmen Ruano, Bocos, Angela Ruiz, Izagirre, Eneritz Urrutia, de Urbina Fernández, Pablo Ortiz, Apodaka, Naiara, Molano, Leire Prieto, Ganuza, Eunate, Vallinas, Iratxe, de Orte, Karmele, Paniagua, Celia González, Ortiz, Gemma, Pérez, Mireia, López, Marta, Bárcena, Estíbaliz, Urutxurtu, Erik, Maroño, Maria Jesús, Escontrela, Blanca, Ereñozaga, Aitziber, Lasuen, Deiene, Zabal, Ainhoa, Guereca, Ane, Adalia, Ramón, Zattera, Luigi, Hernandez, Irina Adalid, Altuna, Leire Larrañaga, Castells, Aina Serrallonga, Garcia, Adriana Vilchez, Núñez, María, Román, Lorena, Calvo, Francisco Javier Redondo, González, Ruben Villazala, González, Victor Baladron, Faba, Patricia, Montenegro, Omar, Ramírez, Natalia Bejarano, Contreras, Sergio Marcos, Rodríguez, Alejandro Garcia, Vázquez, Saleta Rey, Pérez, Cristina Garcia, Miguelez, Eva Higuera, Blanco, Irene Pérez, Rivera, David García, de la Fuente, Ane Martín, Pardo, Marta, Rodriguez, Vanessa, Bengoetxea, Unai, Ramasco, Fernando, Bernal, Sheila Olga Santidrián, Hernando, Alvar Santa Cruz, Domínguez, Beatriz, Lima, Ana Vázquez, Candela, Ángel, Bambaren, Ismael A. Acevedo, Blanco, Maria Isabel Albala, Montoiro, Paloma Alonso, Utrera, Fernando Álvarez, Esteruelas, Juan Avellanosa, López, Amal Azzam, Balvis, Alberto José Balvis, Martín, María Beltrán, Haserfaty, Jacobo Benatar, Camacho, Alberto Berruezo, Weimer, Laura Betolaza, del Mar Carbonell Soto, Maria, Seral, Cristina Carrasco, Zaballos, Cristina Cerro, Llamas, Elizabeth Claros, Orduna, Pilar Coleta, Forero, Ingrid P. Cortes, Agustín, Pascual, Aliseda, Crespo, de Pablo Pajares, María Angélica, Remesal, Yolanda Díez, Díaz, Trinidad Dorado, Blasco, Noemí Echevarría, Martín, María Elena Elías, Triviño, Javier Felices, López, Natalia Fernández, Martín, Cristina Fernández, Pozuelo, Natalia Ferreiro, Martín, Luis Gajate, Santos, Clara Gallego, Mayo, Diego Gil, Rojo, María Gómez, Cibrián, Claudia González, López, Elena Herrera, Olmedillo, Borja Hinojal, Gallego, Berta Iglesias, Khonsari, Sassan, Ruiz, María Nuria Mane, Arroyo, María Manzanero, Ortega, Ana María Mariscal, Burcio, Sara Martín, del Carmen Martín González, María, Grande, Ascensión Martín, López, Jose Juan Martín, Rabes, Cecilia Martín, Borja, Marcos Martínez, Castro, Nilda Martínez, Pérez, Adolfo Martínez, Matcan, Snejana, Viñas, Cristina Medrano, Herrera, Lisset Miguel, Betancur, Adrián Mira, Carbajo, María Montiel, Moradas, Javier Moya, Pérez, Lorena Muñoz, Murias, Mónica Nuñez, González, Eva Ordiales, Recio, Óscar Ordoñez, Rodriguez, Miguel Ángel Palomero, Roux, Diego Parise, Torres, Lucia Pereira, Lagunas, David Pestaña, Corraliza, Juana María Pinto, Rodrigo, Marian Prieto, Diaz-Regaño, Inmaculada Rodriguez, Esteban, David Rodriguez, Pernia, Víctor Rojas, Saiz, Álvaro Ruigómez, Villarino, Bárbara Saavedra, Palero, Noemí Samaranch, Pérez, Gloria Santos, Pérez, Jaume Serna, Romero, Ana Belén Serrano, López, Jesús Tercero, García, Carlos Tiscar, de la Torre Concostrina, Marta, Mesa, Eva María Ureta, Olarte, Eva Velasco, Martínez, Judith Villahoz, Palacios, Raúl Villalaba, García, Gema Villanueva, de Medeiros, Cristina Vogel, Ovejero, Soraya Gholamian, Orgaz, Marta Vicente, Herradon, Patricia Lloreda, Gómez, Cristina Crespo, Sarmiento-Trujillo, Tatiana, Medina, Noemí García, García, María Martínez, Ramírez, Carles Espinós, Rivero, Nabil Mouhaffel, Gil, Jose Antonio Bernia, Martín, Sonsoles, Moral, María Victoria, Galán, Josefina, Paniagua, Pilar, Pérez, Sergio, Bainac, Albert, Arias, Ana, Ramil, Elsa, Escudero, Jorge, Monedero, Pablo, Cara, Carmen, Lara, Andrea, Mendez Martínez, E., Mendoza, Jorge, Baines, Íñigo Rubio, Montero, Alejandro, Ibañez, Rocío Armero, Pitarch, Juan Vicente Llau, Alcover, Fernando Rauer, Herreros, Cristina Álvarez, Martín, Cyntia Sánchez, Olmos, Lucía López Ocáriz, Moruno, Marta Navas, Montoto, Fernando García, Rodriguez, M. F. Mirón, Gamito, Cristina Hernández, Orejudo, Antonio Barba, Vielma, Luis Gerardo Smith, Marín, Yasmina González, de Borja Amador Penco, Francisco, Domínguez, Marta Donoso, Ramírez, Silvia Esquivel, Carbonell, José Antonio, López, Berta Monleón, Martínez-Castro, Sara, Aguilar, Gerardo, Gestal, María, Casas, Pablo, Rosato, Angel Outeiro, Pan, Andrea Naveiro, Portela, María Alonso, Romar, Adrián García, Rodríguez, Eva Mosquera, Seijo, Diego Ruanova, Maceiras, Pablo Rama, Castro-Ceoane, Francisco, López, Esther Moreno, Gil, Sergio, Antón, Julia Guillén, Tirado, Patricia García-Consuegra, Calvo, Aurora Callau, Lisbona, Laura Forés, Romero, María Carbonell, Gil, Belén Albericio, Jarne, Laura Pradal, Lozano, María Soria, López, Diego Loscos, Abarca, Andrea Patiño, Pérez-Asenjo, Jordi Serrano Javier, Díez-Domínguez, Ángel, Zubizarreta, Ion, Ramos, Jon, Fernández, Iosu, Maseda, Emilio, de la Rica, Alejandro Suárez, Veganzones, Javier, Insausti, Itziar, Sagra, Javier, Carrasco, Sofía Díaz, Feijoo, Ana Montero, Garutti, Julio Yagüe. Ignacio, Parga, Eva Bassas, Garcia, Carmen Deiros, Rosa, Elisenda Pujol, Navarro, Ana Tejedor, Gabernet, Roser Font, Bernat, Maria José, Valls, Meritxell Serra, Garcia-Bernalt, Cristina Cobaleda, Anton, Jesus Fernanz, Sierra, Adriana Aponte, Gomez, Lucia Gil, Vaqueiro, Olaia Guenaga, Marin, Susana Hernandez, Pinzon, Laura Pardo, Aranda, Sira Garcia, Orejuela, Carlos Briones, Sanchez, Edgar Cortes, Fernandez, Alejandro Romero, Sanjosé, Esther Fernández, Garsabal, Patricia Iglesias, Lopez, Guillermo Isidro, Vicol, Ana, Malagon, Sara Espejo, Loewe, Maria Sanabra, Torradeflo, Laura Grau, Alcaide, Lourdes Blanco, Sanclemente, Gloria Buenaventura, Serra Pujol, Pere, Mendoza, Gustavo Cuadros, Konarska, Miroslawa, Almenara, Fedra Bachs, Golska, Agnieszka, Blesa, Aleix Carmona, Serra, Arantxa Mas, Melchor, Javier Ripollés, Moreno, Ana Nieto, Novo, Káteri Chao, López, Sandra Gadín, Moreno, Elena Nieto, Tonal, Bérénice Gutiérrez, de Pablo, Elena Lucena, Yañez, Barbara Algar, Rivero, Beatriz Vázquez, Mateo, Beatriz Nozal, de Retes, Marina, Escoda, Norma Aracil, Mayo, Cristina Gallardo, González, Rosa Sanz, Escobar, Alicia Ruiz, López, Maria Laura Pelegrina, Peña, Marina Valenzuela, Dueñas, David Stolle, Motos, Ane Abad, Abad-Gurumeta, Alfredo, Errazquin, Ana Tirado, Ruiz, Elena Sáez, Perez, Nerea Gómez, de Francisco, González, Borja Bau, Serra, Cesar Morcillo, Higueras, Jessica Souto, Vicente, Rosario, Ferrandis, Raquel, Martín, Silvia Polo, Moncho, Azucena Pajares, Puigdollers, Ignacio Moreno, Cortés, Juan Pérez Artacho, Calvo, Ana Moret, Peña, Ana Pi, Fernández, María Catalán, Varela, Marina, Diaz, Pilar, Chiva, María Isabel Forés, Agulló, A. Javier, Pérez, Antonio, Barrionuevo, María, Medrano, Paloma, Sanz, Cristina, Ortega, Manuel, Galiana, Maria, Margarit, Antoni, del Rio, Válerie Mourre, Muxella, Eva Heras, and Vidal, Anna

Subjects
Mechanical ventilation, ARDS, Acute respiratory distress syndrome, business.industry, Original, medicine.medical_treatment, Hazard ratio, 030208 emergency & critical care medicine, medicine.disease, Critical Care and Intensive Care Medicine, 3. Good health, Coronavirus, 03 medical and health sciences, Plateau pressure, Prone position, 0302 clinical medicine, 030228 respiratory system, Anesthesia, Intensive care, Breathing, Medicine, business, Tidal volume, Outcome
Abstract

Purpose The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients. Results A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3–7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11–14) cmH2O. Values of respiratory system compliance 35 (27–45) ml/cmH2O, plateau pressure 25 (22–29) cmH2O, and driving pressure 12 (10–16) cmH2O were similar cto values from non-COVID-19 ARDS observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33–0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47–0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients. Conclusions In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity. Electronic supplementary material The online version of this article (10.1007/s00134-020-06192-2) contains supplementary material, which is available to authorized users.

Published
2020

5. SuperNO2VA in COVID-19 critical ill patients. An alternative for non-invasive respiratoryort

Author

Angélica De Pablo Pajares and Ramiro Adrián Mira Betancur

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), coronavirus, law.invention, law, CPAP, Anesthesiology, Health care, Pandemic, Medicine, soporte respiratorio no invasivo, General Materials Science, non-invasive respiratoryort, business.industry, Critically ill, pandemia, respiratory failure, COVID-19, neumonía, SuperNO2VA, medicine.disease, Intensive care unit, insuficiencia respiratoria, Respiratory support, Pneumonia, Medical emergency, Pandemicpneumonia, business
Abstract

Coronavirus disease 2019 (COVID-19) was known at the end of last year, initially in the Wuhan province of China, but it spread quickly throughout the world and in February 2020 it was already present in several countries on all continents; in mild-March the world health organization (WHO) officially declared it a pandemic. The clinical spectrum ranges from asymptomatic or mildly clinical to situation with high mortality mainly due to severe acute respiratory failure or sepsis and multi-organ failure. The majority of critically ill patients admitted to critical care unit require invasive, non-invasive respiratory support or a combination of both. The great avalanche of patients who entered to the Madrid hospitals in a very short period of time conditioned unprecedent healthcare pressure on the system and required a structural and functional reorganization of all centers and at all levels. This great demand made the available resources at times clearly insufficient and it was necessary to improvise aid and support mechanisms as well as diversify structures and resources even in unusual places and conditions. The crating works team and equipping new ICU beds was one of the greatest needs; at this scenery the Anesthesiology and Reanimation services were fundamental given their capacity for adaptation and aptitud in supporting and managing the critically iil patient. Non-invasive respiratory support is a fundamental strategy for management of patients with severe acute respiratory failure, both inside and outside ICU; the differents devices available provide their functionally in various clinical situations, although in the beginning of the pandemic their use was not very widespread, first due to fear failure of the technique and second and most importantly due to staff fear of infection by the aerosol dispersion; its efficacy has finally been recognized in situations where the indication is appropriate, the correct time and appropriate facilities. The PAP SuperNO2VA is a device that is little known until now and that can be useful in specifics cases. In this article, we aim to describe the key characteristics of COVID-19 pneumonia and the role of SRNI systems play in its management, specifically the SuperNO2VA. We describe some cases of its use in clinical settings during the pandemic., La enfermedad por coronavirus 2019 ( COVID-19) se conoció a finales del 2019, inicialmente en la provincia China de Wuhan, pero se extendió de manera rápida a lo largo del mundo y en Febrero de 2020 ya estaba presente en varios países de todos los continentes; a mediados de Marzo la Organización Mundial de La salud ( OMS) la declaró oficialmente como pandemia. El espectro clínico abarca desde cuadros asintomáticos o con sintomatología leve hasta situaciones graves potencialmente mortales debido sobre todo a insuficiencia respiratoria aguda hipoxémica , sepsis o fracaso multiorgánico. La mayoría de pacientes graves que ingresan en la Unidad de Cuidados Críticos (UCI) requiere soporte respiratorio invasivo, no invasivo o la combinación de ambos. La gran avalancha de pacientes que ingresaron en los hospitales de Madrid en un periodo muy corto de tiempo condicionó una presión asistencial sin precedentes en el sistema sanitario y precisó de una reorganización estructural y funcional a todos los niveles; esta gran exigencia hizo que por momentos la disponibilidad de algunos recursos resultara claramente insuficiente y fue necesario improvisar mecanismos de ayuda y soporte así como diversificar estructuras y medios incluso en sitios poco habituales; la creación de equipos de trabajo y el equipamiento de camas de UCI fue una las mayores necesidades; en este escenario la labor del servicio de Anestesiología y Reanimación resultó fundamental dada su capacidad de adaptación y la destreza probada en el soporte y manejo del paciente crítico. El soporte respiratorio no invasivo (SRNI) es una estrategia clave para el manejo del paciente con insuficiencia respiratoria aguda grave, tanto dentro como fuera de la UCI; es cierto que al principio de la pandemia su uso no fue muy extendido, primero por el temor al fallo de la técnica y segundo y más importante por el temor fundado del personal sanitario al contagio por la dispersión de aerosoles; finalmente se ha reconocido su eficacia si se aplica con la indicación adecuada, en el momento correcto y en las instalaciones apropiadas. La mascarilla SuperNO2VA es un dispositivo poco conocido hasta ahora y que en situaciones como la que enfrentamos puede resultar de gran utilidad en casos concretos. En este artículo pretendemos describir las características clave de la neumonía por COVID-19 y el papel que juegan los sistemas de SRNI en su manejo, en concreto la mascarilla de PAP SuperNO2VA, describimos algunos casos de su uso en diversos escenarios.

Published
2021
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