Manuella Pons1,2, François Morin3, Guillaume Carteaux4,5,6, Samuel Tuffet7,1,8, Arnaud Lesimple9,10, Bilal Badat10, Anne-Fleur Haudebourg7,1,8, François Perier7,1,8, Yvon Deplante1, Constance Guillaud11, Frédéric Schlemmer8,12, Elena Fois13, Nicolas Mongardon14, Mehdi Khellaf15, Karim Jaffal16, Camille Deguillard17, Philippe Grimbert18, Raphaëlle Huguet17, Keyvan Razazi7,1,8, Nicolas de Prost7,1,8, François Templier3, François Beloncle9,19, Alain Mercat9,19, Laurent Brochard20,21, Vincent Audard18,22, Pascal Lim8,17, Jean-Christophe Richard19,23, Dominique Savary3,24, Armand Mekontso Dessap7,1,8. 1. Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France. 2. Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France. 3. Département de Médecine d'Urgence, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France. 4. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. guillaume.carteaux@aphp.fr. 5. Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France. guillaume.carteaux@aphp.fr. 6. INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France. guillaume.carteaux@aphp.fr. 7. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert Chenevier, Service de Médecine Intensive Réanimation, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. 8. INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France. 9. CNRS, INSERM 1083, MITOVASC, Université d'Angers, Angers, France. 10. Laboratoire Med2Lab ALMS, Antony, France. 11. Département d'Aval des Urgences, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France. 12. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Unité de Pneumologie, 94010, Créteil, France. 13. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Unité des Maladies Génétiques du Globule Rouge, 94010, Créteil, France. 14. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service d'Anesthésie-Réanimation Chirurgicale, 94010, Créteil, France. 15. Emergency Department, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France. 16. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service d'immunologie Clinique Et Maladies Infectieuses, 94010, Créteil, France. 17. Department of Cardiovascular Medicine, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France. 18. Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », 94010, Créteil, France. 19. Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, Centre Hospitalier Universitaire d'Angers, Vent' Lab, Université d'Angers, Angers, France. 20. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. 21. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. 22. Université Paris Est-Créteil, INSERM, IMRB, Equipe 21, 94010, Créteil, France. 23. INSERM, UMR 1066, Créteil, France. 24. IRSET (Institut de Recherche en Santé, environnement et travail)-UMR_S 1085, 49000, Angers, France.
Abstract
BACKGROUND: We describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19 patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter ("Filter Frugal CPAP", FF-CPAP) in and out the ICU. METHODS: (1) A bench study measured the impact of two filters with different mechanical properties on CPAP performances, and pressures were also measured in patients. (2) Non-ICU healthcare staff working in COVID-19 intermediate care units were trained with a video tutorial posted on a massive open online course. (3) A clinical study assessed the feasibility and safety of using FF-CPAP to maintain oxygenation and manage patients out of the ICU during a massive outbreak. RESULTS: Bench assessments showed that adding a filter did not affect the effective pressure delivered to the patient. The resistive load induced by the filter variably increased the simulated patient's work of breathing (6-34%) needed to sustain the tidal volume, depending on the filter's resistance, respiratory mechanics and basal inspiratory effort. In patients, FF-CPAP achieved pressures similar to those obtained on the bench. The massive training tool provided precious information on the use of Boussignac FF-CPAP on COVID-19 patients. Then 85 COVID-19 patients with ICU admission criteria over a 1-month period were studied upon FF-CPAP initiation for AHRF. FF-CPAP significantly decreased respiratory rate and increased SpO2. Thirty-six (43%) patients presented with respiratory indications for intubation prior to FF-CPAP initiation, and 13 (36%) of them improved without intubation. Overall, 31 patients (36%) improved with FF-CPAP alone and 17 patients (20%) did not require ICU admission. Patients with a respiratory rate > 32 breaths/min upon FF-CPAP initiation had a higher cumulative probability of intubation (p < 0.001 by log-rank test). CONCLUSION: Adding a filter to the Boussignac valve does not affect the delivered pressure but may variably increase the resistive load depending on the filter used. Clinical assessment suggests that FF-CPAP is a frugal solution to provide a ventilatory support and improve oxygenation to numerous patients suffering from AHRF in the context of a massive outbreak.
BACKGROUND: We describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter ("Filter Frugal CPAP", FF-CPAP) in and out the ICU. METHODS: (1) A bench study measured the impact of two filters with different mechanical properties on CPAP performances, and pressures were also measured in patients. (2) Non-ICU healthcare staff working in COVID-19 intermediate care units were trained with a video tutorial posted on a massive open online course. (3) A clinical study assessed the feasibility and safety of using FF-CPAP to maintain oxygenation and manage patients out of the ICU during a massive outbreak. RESULTS: Bench assessments showed that adding a filter did not affect the effective pressure delivered to the patient. The resistive load induced by the filter variably increased the simulated patient's work of breathing (6-34%) needed to sustain the tidal volume, depending on the filter's resistance, respiratory mechanics and basal inspiratory effort. In patients, FF-CPAP achieved pressures similar to those obtained on the bench. The massive training tool provided precious information on the use of Boussignac FF-CPAP on COVID-19patients. Then 85 COVID-19patients with ICU admission criteria over a 1-month period were studied upon FF-CPAP initiation for AHRF. FF-CPAP significantly decreased respiratory rate and increased SpO2. Thirty-six (43%) patients presented with respiratory indications for intubation prior to FF-CPAP initiation, and 13 (36%) of them improved without intubation. Overall, 31 patients (36%) improved with FF-CPAP alone and 17 patients (20%) did not require ICU admission. Patients with a respiratory rate > 32 breaths/min upon FF-CPAP initiation had a higher cumulative probability of intubation (p < 0.001 by log-rank test). CONCLUSION: Adding a filter to the Boussignac valve does not affect the delivered pressure but may variably increase the resistive load depending on the filter used. Clinical assessment suggests that FF-CPAP is a frugal solution to provide a ventilatory support and improve oxygenation to numerous patients suffering from AHRF in the context of a massive outbreak.
Authors: François Perier; Samuel Tuffet; Tommaso Maraffi; Glasiele Alcala; Marcus Victor; Anne-Fleur Haudebourg; Nicolas De Prost; Marcelo Amato; Guillaume Carteaux; Armand Mekontso Dessap Journal: Am J Respir Crit Care Med Date: 2020-12-15 Impact factor: 21.405
Authors: Andrey I Yaroshetskiy; Zamira M Merzhoeva; Natalia A Tsareva; Natalia V Trushenko; Galia S Nuralieva; Vasily D Konanykhin; Anna P Krasnoshchekova; Sergey N Avdeev Journal: BMC Anesthesiol Date: 2022-10-01 Impact factor: 2.376