EN | TR
E-ISSN: 2602-2974
Evaluation of Alveolo-arterial Oxygen Gradient and Mortality in Different Respiratory Support Methods in Severe COVID-19 Patients Followed in the Intensive Care Unit
PDF
Cite
Share
Request
Original Research
VOLUME: 21 ISSUE: 3
P: 190-195
September 2023

Evaluation of Alveolo-arterial Oxygen Gradient and Mortality in Different Respiratory Support Methods in Severe COVID-19 Patients Followed in the Intensive Care Unit

J Turk Soc Intens Care 2023;21(3):190-195
DOI: 10.4274/tybd.galenos.2022.37929
Fatih Sargın
Anıl Kuvandık
Simay Karaduman
Hülya Sungurtekin
1. Pamukkale Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Denizli, Türkiye
2. Pamukkale Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Denizli, Türkiye
No information available.
No information available
Received Date: 25.08.2022
Accepted Date: 19.10.2022
Publish Date: 26.09.2023
PDF
Cite
Share
Request

ABSTRACT

Objective:

Severe pneumonia is an important cause of mortality in coronavirus disease-2019 (COVID-19) infection. This study evaluated pulmonary gas exchange and mortality according to nasal cannula, high flow nasal cannula, non-invasive positive pressure ventilation and invasive mechanical ventilation used for treating hypoxemic respiratory failure in severe COVID-19 patients.

Materials and Methods:

Hundred and forty severe COVID-19 patients who were treated in Department of Anesthesiology Intensive Care Unit of Pamukkale University Hospital were reviewed retrospectively. Arterial blood gas results on the 1st, 3rd, 7th, 14th, and 21st days of admission were recorded.

Results:

The alveolo-arterial oxygen gradient of the patients receiving oxygen via nasal cannula was significantly lower than the patients receiving high-flow nasal cannula, non-invasive and invasive mechanical ventilation. When the other groups were compared, no significant difference was observed between the alveolo-arterial oxygen gradients of the patients who received high-flow nasal cannula, non-invasive and invasive mechanical ventilation support. We observed that the mortality of the patients who were admitted as intubated was significantly higher than the other groups.

Conclusion:

Invasive and non-invasive oxygen support resulted in similar alveolo-arterial oxygen gradients in severe COVID-19 patients at admission and at 3-week follow-up, but mortality was higher in intubated patients.

Keywords: COVID-19, nasal cannula, oxygen treatment, alveolo-arterial oxygen gradient, mechanical ventilation

References

1
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents 2020;55:105924.
2
Camporota L, Cronin JN, Busana M, Gattinoni L, Formenti F. Pathophysiology of coronavirus-19 disease acute lung injury. Curr Opin Crit Care 2022;28:9-16.
3
Singh A, Soni KD, Singh Y, Aggarwal R, Venkateswaran V, Ashar MS, et al. Alveolar Arterial Gradient and Respiratory Index in Predicting the Outcome of COVID-19 Patients; a Retrospective Cross-Sectional Study. Arch Acad Emerg Med 2022;10:e28.
4
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020;20:425-34.
5
Chiumello D, Busana M, Coppola S, Romitti F, Formenti P, Bonifazi M, et al. Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study. Intensive Care Med 2020;46:2187-96.
6
Churpek MM, Gupta S, Spicer AB, Parker WF, Fahrenbach J, Brenner SK, et al. Hospital-Level Variation in Death for Critically Ill Patients with COVID-19. Am J Respir Crit Care Med 2021;204:403–11.
7
Oranger M, Gonzalez-Bermejo J, Dacosta-Noble P, Llontop C, Guerder A, Trosini-Desert V, et al. Continuous positive airway pressure to avoid intubation in SARS-CoV-2 pneumonia: a two-period retrospective case-control study. Eur Respir J 2020;56:2001692.
8
Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med 2020;46:1099-102.
9
Castaneda C, Ah Rhee CJ, Magh A, Eng C, Mann J, Sanso L, et al. Impact of ventılator model on mortalıty: a retrospectıve cross-sectıonal study ın 147 mechanıcally ventılated patıents wıth COVID-19 ARDS. Chest 2020;158:A617
10
Brusasco C, Corradi F, Di Domenico A, Raggi F, Timossi G, Santori G, et al. Continuous positive airway pressure in COVID-19 patients with moderate-to-severe respiratory failure. Eur Respir J 2021;57:2002524.
11
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.
12
Mellado-Artigas R, Ferreyro BL, Angriman F, Hernández-Sanz M, Arruti E, Torres A, et al. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Crit Care 2021;25:58.
13
Vaschetto R, Barone-Adesi F, Racca F, Pissaia C, Maestrone C, Colombo D, et al. Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit. ERJ Open Res 2021;7:00541-2020.
14
Dupuis C, Bouadma L, de Montmollin E, Goldgran-Toledano D, Schwebel C, Reignier J, et al. Association Between Early Invasive Mechanical Ventilation and Day-60 Mortality in Acute Hypoxemic Respiratory Failure Related to Coronavirus Disease-2019 Pneumonia. Crit Care Explor 2021;3:e0329.
15
Daniel P, Mecklenburg M, Massiah C, Joseph MA, Wilson C, Parmar P, et al. Non-invasive positive pressure ventilation versus endotracheal intubation in treatment of COVID-19 patients requiring ventilatory support. Am J Emerg Med 2021;43:103-8.
16
Ferreyro BL, Angriman F, Munshi L, Del Sorbo L, Ferguson ND, Rochwerg B, et al. Association of Noninvasive Oxygenation Strategies With All-Cause Mortality in Adults With Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-analysis. JAMA 2020;324:57-67.
17
Ángel Mejía VE, Arango Isaza D, Fernández Turizo MJ, Vasquez Trespalacios EM, Rincón JA. High flow nasal cannula useful for severe SARSs-CoV-2 pneumonia. Med Intensiva (Engl Ed) 2022;46:107-9.
18
Perkins GD, Ji C, Connolly B, Couper K, Lall R, Baillie K, et al. An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19. medRxiv 2021:1-25.
19
Santus P, Pini S, Amati F, Saad M, Gatti M, Mondoni M, et al. Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study. Can Respir J 2022;2022:1499690.
20
Weerakkody S, Arina P, Glenister J, Cottrell S, Boscaini-Gilroy G, Singer M, et al. Non-invasive respiratory support in the management of acute COVID-19 pneumonia: considerations for clinical practice and priorities for research. Lancet Respir Med 2022;10:199-213.
21
Guérin C, Albert RK, Beitler J, Gattinoni L, Jaber S, Marini JJ, et al. Prone position in ARDS patients: why, when, how and for whom. Intensive Care Med 2020;46:2385-96.
2024 ©️ Galenos Publishing House