CHEST Guidelines-Respiratory-Support-Techniques-for-COVID-19-Relate

Respiratory-Support-Techniques-for-COVID-19-Relate

Pdf Summary

This observational study examines respiratory support techniques for COVID-19-related acute respiratory distress syndrome (ARDS) in Uganda, involving 499 patients from 13 hospitals. Common respiratory supports used were standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV). The study found that 37.3% of patients initially received SOX, 10% HFNO, 11.6% CPAP, 23.4% NIV, and 17.6% IMV. Respiratory support was escalated for 19.8% of the participants.<br /><br />The 28-day mortality rate varied significantly across the respiratory support techniques and ARDS severity. SOX had the lowest associated mortality (19.9%), followed by HFNO (31.9%), CPAP (58.3%), NIV (61.1%), and IMV (83.9%). Mortality was highest in severe ARDS cases and among those requiring mechanical ventilation, highlighting the challenge of managing these patients in a resource-constrained setting.<br /><br />Awake prone positioning was used in 15.8% of cases and correlated with a lower mortality rate (40.5% vs 54% without proning). The study suggests that abundant use of SOX and HFNO, alongside awake proning, might offer better outcomes in such contexts.<br /><br />The study highlights the severe limitations in ICU capacity and resources in Uganda, which impacted the management and outcomes for patients with COVID-19 ARDS. Independent risk factors for mortality included the use of NIV or IMV, lower initial oxygenation, and higher respiratory rates on admission. The findings underscore resource-related challenges and call for increased focus on effective early intervention strategies in resource-limited settings to reduce mortality.

Keywords

COVID-19

ARDS

Uganda

respiratory support

mortality rate

oxygen therapy

ICU capacity

resource constraints

awake proning

early intervention