Article ; Online: Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study.
2023 Volume 164, Issue 2, Page(s) 369–380
Abstract: Background: Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS.: Research question: Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda?: Study ... ...
| Abstract | Background: Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS. Research question: Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda? Study design and methods: A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded. Standard tests, log-rank tests, and logistic regression analyses were used for statistical analyses. Results: Four hundred ninety-nine patients with COVID-19-associated ARDS (mild, n = 137; moderate, n = 247; and severe, n = 115) were included (ICU admission, 38.9%). Standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) was used as the first-line (most advanced) respiratory support technique in 37.3% (35.3%), 10% (9.4%), 11.6% (4.8%), 23.4% (14.4%), and 17.6% (36.6%) of patients, respectively. The first-line respiratory support technique was escalated in 19.8% of patients. Twenty-eight-day mortality was 51.9% (mild ARDS, 13.1%; moderate ARDS, 62.3%; severe ARDS, 75.7%; P < .001) and was associated with respiratory support techniques as follows: SOX, 19.9%; HFNO, 31.9%; CPAP, 58.3%; NIV 61.1%; and IMV, 83.9% (P < .001). Proning was used in 79 patients (15.8%; 59 of 79 awake) and was associated with lower mortality (40.5% vs 54%; P = .03). The oxygen saturation to Fio Interpretation: SOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda. Although these data are observational, they suggest that the use of SOX and HFNO therapy as well as awake proning are associated with a lower mortality resulting from COVID-19-associated ARDS in a resource-limited setting. |
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| MeSH term(s) | Adult ; Humans ; COVID-19/complications ; COVID-19/therapy ; Prospective Studies ; Oxygen/therapeutic use ; Noninvasive Ventilation/methods ; Respiratory Distress Syndrome/therapy ; Respiratory Distress Syndrome/drug therapy ; Africa South of the Sahara/epidemiology | ||||||||||
| Chemical Substances | Oxygen (S88TT14065) | ||||||||||
| Language | English | ||||||||||
| Publishing date | 2023-02-10 | ||||||||||
| Publishing country | United States | ||||||||||
| Document type | Multicenter Study ; Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't | ||||||||||
| ZDB-ID | 1032552-9 | ||||||||||
| ISSN | 1931-3543 ; 0012-3692 | ||||||||||
| ISSN (online) | 1931-3543 | ||||||||||
| ISSN | 0012-3692 | ||||||||||
| DOI | 10.1016/j.chest.2023.01.039 | ||||||||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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