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Recognizing patients that best benefited from non-invasive respiratory therapies (NRTs) in intermediate respiratory care units (IRCU) is crucial to ensure management and limiting resources during COVID pandemic. To assess factors associated with survival, intensive care unit (ICU) admission and intubation likelihood in COVID-19 patients admitted to IRCU.Methods Observational retrospective study in consecutive patients admitted to IRCU of a tertiary hospital from March-2020 to April-2021. Inclusion criteria: Hypoxemic respiratory failure (Sp02 =25rpm with Fi02 >50% supplementary oxygen) due to acute COVID-19 infection. Demographic, comorbidities, clinical and analytical data, medical and NRTs were collected at IRCU admission. Multivariate logistic regression models assessed factors associated with survival, ICU admission and intubation. Results From 679 patients, 79 patients (12%) had order to do not intubation. From de remaining 600 (88%), 81% survived, 41% needed ICU admission and 37% required intubation. During IRCU, 51% required non-invasive ventilation (NIV group) and 49% did not (non-NIV group). Longer age and lack of corticosteroid treatment were associated with higher mortality and intubation risk in the entire cohort and among NIV group; among non-NIV group, lack of corticosteroids (any regimen) was associated with higher mortality; Admission during the first wave, and higher serum lactate dehydrogenase (LDH) and C-reactive protein (CRP) were associated with higher intubation risk. Conclusions 57% improved at IRCU with no ICU admission. The use of corticosteroids improved outcomes. A bolus plus progressive tapering scheme could be more beneficial in severe forms. Initial NIV does not always mean worse outcomes.

espanolObjetivo: identificar los beneficios y los principales cuidados del dispositivo de canula nasal de alto flujo como tratamiento en los pacientes diagnosticados de insuficiencia respiratoria aguda (IRA). Metodo: se ha realizado una revision narrativa. Se buscaron articulos en las siguientes bases de datos: PubMed, Cinhal, Cochrane Library Plus y Cuiden, con los siguientes terminos libres de busqueda: oxigenoterapia alto flujo; insuficiencia respiratoria aguda y cuidados enfermeros. Limitados con idioma ingles o espanol, edad +18 anos y publicados en los ultimos 10 anos (2007-2017). Resultados: se incluyeron 19 documentos. El principal beneficio del tratamiento con dispositivo de canula nasal de alto flujo es la mejora de la oxigenacion. La terapia utiliza un sistema de humidificacion termica que favorece la funcion mucociliar, facilita la expulsion de secreciones y reduce la aparicion de atelectasias pulmonares. Ademas, mediante la humidificacion del aire inspirado se reducen las molestias de la sequedad bucal relacionadas con la oxigenoterapia convencional. Puede llegar a aliviar asincronias, reducir la frecuencia respiratoria y mejorar la eficacia tambien de los esfuerzos respiratorios incrementando la ventilacion alveolar. Conclusiones: el uso de la canula nasal de alto flujo es un tratamiento beneficioso en los pacientes diagnosticados de insuficiencia respiratoria aguda. EnglishObjective: to identify the benefits and main care measures for the high-flow nasal cannula as treatment for patients diagnosed with acute respiratory failure. Method: a narrative review was conducted; there was a search for articles in the following databases: PubMed, Cinhal, Cochrane Library Plus and Cuiden, with the following free search terms: “oxigenoterapia alto flujo” (high-flow oxygen therapy); “insuficiencia respiratoria aguda” (acute respiratory failure) and “cuidados enfermeros” (nursing care).The search was limited to articles in English or Spanish, >18-year-old, and published within the past 10 years (2007-2017). Results: nineteen (19) articles were included. The main benefit of the treatment with high-flow nasal cannula was an improvement in oxygenation. This therapy involves a thermal humidification system that boosts the mucociliary function, encourages the discharge of secretions, and reduces the development of pulmonary atelectasis. Moreover, through the humidification of the air inhaled, there is a reduction in the mouth dryness discomfort associated with traditional oxygen therapy. It can even alleviate asynchrony, reduce the respiratory frequency, and improve also the efficacy of respiratory efforts, by increasing alveolar ventilation. Conclusions: the use of high-flow nasal cannula is a beneficial treatment for patients diagnosed with acute respiratory failure.

Different kinds of ventilators are available to perform noninvasive ventilation (NIV) in ICUs. Which type allows the best patient-ventilator synchrony is unknown. The objective was to compare patient-ventilator synchrony during NIV between ICU, transport—both with and without the NIV algorithm engaged—and dedicated NIV ventilators.First, a bench model simulating spontaneous breathing efforts was used to assess the respective impact of inspiratory and expiratory leaks on cycling and triggering functions in 19 ventilators. Second, a clinical study evaluated the incidence of patient-ventilator asynchronies in 15 patients during three randomized, consecutive, 20-min periods of NIV using an ICU ventilator with and without its NIV algorithm engaged and a dedicated NIV ventilator. Patient-ventilator asynchrony was assessed using flow, airway pressure, and respiratory muscles surface electromyogram recordings.On the bench, frequent auto-triggering and delayed cycling occurred in the presence of leaks using ICU and transport ventilators. NIV algorithms unevenly minimized these asynchronies, whereas no asynchrony was observed with the dedicated NIV ventilators in all except one. These results were reproduced during the clinical study: The asynchrony index was significantly lower with a dedicated NIV ventilator than with ICU ventilators without or with their NIV algorithm engaged (0.5% [0.4%-1.2%] vs 3.7% [1.4%-10.3%] and 2.0% [1.5%-6.6%], P.01), especially because of less auto-triggering.Dedicated NIV ventilators allow better patient-ventilator synchrony than ICU and transport ventilators, even with their NIV algorithm. However, the NIV algorithm improves, at least slightly and with a wide variation among ventilators, triggering and/or cycling off synchronization.