How to effectively combat respiratory failure in patients with COVID-19

La Respiratory failure is an important cause of death in patients with COVID-19. Respiratory and Invasive Strategies (NIRS) are the ones that are used extensively in these patients to save the life. According to experts, NIRS technology can reduce the need for invasive mechanical ventilation (VMI) in patients with acute respiratory failure, but patients who do not respond to NIRS have poor results.

This error of reply must be particularly Important in patients with COVID-19, the availability of medical attention services can be limited during the pandemic. For this reason, it would benefit from the temporary identification of patients with COVID-19 that is unlikely to respond to treatment with NIRS.

Studies in patients with other respiratory infections was informed that the pH was low, the score was low on the Glasgow coma scale and the oxygenation was low, and the high cardiac frequency, the high respiratory rate and the current volume are associated with VNI insufficiency.

In the same way, a series of clinical variables and oxygenation, including the clinical increase in oxygenation or the reduction of respiratory frequency, were associated with HFNC insufficiency and VMI posterior urgency. Therefore, the majority of these variables have a limited value in identifying patients who need posterior intubation. In envirmos with respiratory insufficiency aguda and neumonia, the index of respiratory-oxygen frequency (ROX), based on medium oxygen saturation by pulse oximetry (SpO 2), inspired oxygen fraction (FiO 2) and respiratory failure to identify intubation and fall risk of NIRS.

Without embarrassment, it is known that its users are used to identify patients with COVID-19 with a high risk of NIRS failure. The objective of this study was to develop and validate a simple nomogram and an online calculator to predict the risk of NIRS failure in patients with COVID-19 which presents acute respiratory failure. In a study conducted by professionals at Zhongda Hospital of the University of Sureste in China, we developed and validated a nomogram and an online calculator for the predictive temperature of NIRS in patients with COVID-19.

Key to cure

The name, based on the oath, the number of comorbidities, the ROX index, the score of the Glasgow coma scale and the use of vasopressors on day 1 of NIRS, has a discriminatory capacity of 95en the prediction of NIRS cases. The patients in the fall of the NIRS have a high risk of death. Therefore, the temporary prediction of NIRS fractions should help physicians adequately assign critical care resources and identify high-risk patients for admission to clinical trials.

In distinct respiratory tract infections of COVID-19, several studies have demonstrated that intubation following the initial use of VNI or HFNC is associated with poor outcomes, such as an increase in mortality, in patients with acute respiratory failure. Precursors of the NIRS are the most important and patients with COVID-19, given the limited resources available during the pandemic.

Although Preliminary studies have suggested that the criteria for initiating HFNC or NIV and their results may differ, finding that the Majority of the Independent Factors for NIRS fractions is superimposed on the HFNC and NIV groups in the cohort of. Hecho, the 26% receive HFNC and VNI at different times during the course of their illness. We will verify a predictive scale prevalent for VNI fractures in patients without COVID-19 (based on cardiac frequency, acidosis, consciousness, oxygenation and respiratory frequency).

The study showed that NIRS failed in 64% of the cases in the training cohort and in 69% of the cases in the external validation cohort; These values ​​are more important than the previously reported failure rate for HFNC (28-38%) and VNI (39–50%). Mortality in the 28 days in the cohort of external training and validation of 54% and 63%, among the range of 16-78% predominantly described in patients with COVID-19 admitted to a UCI.

Without embarrassment, patients in the fractures of the NIRS will receive a mortal death from the mayor who reported prematurely in other respiratory afflictions after the fall of the NIV or the HFNC. Because the prediction model is simple and fast to use in the clinical setting, specialists only focus on risk factors that do not require laboratory parameters.

In conclusion, the nomogram and online calculator are easy to use and can predict the risk of falls in patients with COVID-19 treated with HFNC and NIV. Both can be used to identify patients with a high probability of NIRS failure. These patients can benefit from a temperament classification and a more intensive follow-up. Benefits of a strategy of this type, which may include temperate intubation, require confirmation in randomized controlled trials.

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