How I Do It: High Flow, Non-invasive ventilation and Awake (non-intubation) Proning in Covid-19 Patients with Respiratory Failure.
ABSTRACT:
The Covid 19 pandemic will be remembered for the rapidity with which it spread,
the morbidity and mortality associated with it and the paucity of evidence-based
management guidelines. One of the major concerns of hospitals was to limit spread
of infection to health care workers. Since the virus is spread mainly by respiratory
droplets and aerosolized particles, procedures which may potentially disperse viral
particles, the so called “aerosol-generating procedures” or AGPs were avoided
whenever possible. Included in this category were non-invasive ventilation (NIV),
high flow nasal cannula (HFNC) and awake (non-intubated) proning. Accordingly,
at many health care facilities, patients who had increasing oxygen requirements
were emergently intubated and mechanically ventilated to avoid exposure to AGPs.
With experience, clinicians realized that mortality of invasively ventilated patients
was high and it was not easy to extubate many of these patients. This raised the
concern that HFNC and NIV were being underutilized to avoid intubation and to
facilitate extubation. In this article, we attempt to separate fact from fiction and
perception from reality pertaining to the aerosol dispersion with NIV, HFNC and
AP. We describe precautions that hospitals and health care providers must take to
mitigate risks with these devices. Finally, we take a practical approach in
describing how we use the three techniques, including the common indications,
contraindications and practical aspects of application.
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REFERÊNCIA:
RAOOF, Suhail et al. How I Do It: High Flow, Non-invasive ventilation and Awake (non-intubation) Proning in Covid-19 Patients with Respiratory Failure. CHEST Journal, [S. l.], p. 1-17, 12 ago. 2020.
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