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Prolonged use of non-invasive ventilation in patients with COVID 19: a case report

100%
Singh K., Kumar A., Kumar N., Kumar A., SK A.
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XX
One of the most commonly affected organ systems by SARS-CoV-2 virus is the respiratory system. Major challenge with coronavirus disease is managing the pulmonary complications. Role of non-invasive ventilation in patients of coronavirus disease 2019 (COVID 19) has been questioned in spite of evidence showing its use in acute hypoxemic respiratory failure. Patient selection is very important when using non-invasive ventilation for management of respiratory failure due to COVID 19. Here we report a case of COVID 19 with respiratory failure that was managed successfully with prolonged use of non-invasive ventilation.
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Monitoring and evaluation of muscle atrophy: a much needed step in critically ill COVID-19 patients

86%
Kumar A., Kumar A., Kumar N., Kumar A., Sinha C., Kumari P., Singh V.
Critical Care Innovations
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2021
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vol. 4
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issue 1
30-43
XX
INTRODUCTION: Elderly COVID-19 patients admitted to the intensive care unit (ICU) are at high risk of an inflammatory syndrome, hypercatabolic reaction, malnutrition, and physical immobilization. This may result in loss of muscle mass and pulmonary infection leading to prolonged ventilatory support. Factors responsible for muscle mass loss in ICU are (1) microcirculatory disturbances, (2) presence of systemic inflammatory response syndrome (SIRS), (3) sepsis (4) drugs (corticoids, neuromuscular blockers) having inhibitory activity on the nervous system, neuromuscular junction and muscle itself. Mechanism of muscle atrophy in critically ill elderly patients include an imbalance between protein synthesis and degradation. Interventions to manage muscle atrophy for the patients admitted to ICU is also extrapolated to mechanically ventilated COVID-ARDS patients. PURPOSE: Early recognition of factors contributing to intensive care unit acquired weakness (ICUAW) in COVID-19 patients, inflammation, high catabolic phase, steroid use, and paralysis. The potential interventions to target these specific mechanisms and ameliorate muscle dysfunction in COVID-19 patients. CONCLUSIONS:Intensive care unit acquired weakness (ICUAW) in critically ill COVID-19 patients is due to severity of illness, co-morbidities, muscle unloading, or ICU treatments, a systemic reaction circulating within the body, or combinations therein. Furthermore, the availability of a culture model of ICUAW could facilitate in expediting the diagnosis of ICUAW and fast track the discovery of putative treatments. We recommend NIV or HFNC ventilation or early weaning from invasive mechanical ventilation in critically ill COVID-19 elderly patients.
3
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Physiological mechanism of resistant hypoxemia during dialysis of COVID 19 patient: a case report.

86%
Kumar A., Kumar A., Kumar A., Sinha C., Kumari P., Singh P. K.
Critical Care Innovations
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2021
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vol. 4
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issue 3
15-19
EN
Chronic kidney disease (CKD) is characterized by loss of kidney function and generally it is associated with several alterations in pulmonary functions, including restriction, obstruction, and impaired diffusion capacity. It became challenging to maintain oxygenation in a CKD patient associated with COVID 19 on non-invasive ventilation (NIV). In patients with end stage renal disease (ESRD), several factors likes, fluid overload, anaemia, immune suppression, extraosseous calcification, malnutrition, electrolyte imbalance, and acid-base disorder affecting the lungs indirectly. Here we are reporting NIV failure in two COVID 19 patients during dialysis. Both patients were stable on NIV before starting dialysis and underwent oxygen desaturation and shifted to invasive mechanical ventilation during hemodialysis. The possible mechanism of the oxygen desaturation is alveolar hypoventilation in the absence of hypercapnia, which may be due to the removal of CO2 from the body by some route (dialysate) other than the lungs.
PL
Przewlekła choroba nerek (PChN) charakteryzuje się utratą funkcji nerek i generalnie wiąże się z kilkoma zmianami w czynnościach płuc, w tym ograniczeniem, niedrożnością i upośledzeniem zdolność dyfuzyjnej. Podczas wentylacji nieinwazyjnej (NIV) u pacjenta z PChN związanego z COVID 19 wystąpiły problemy z utrzymaniem odpowiedniego utlenowania. Pacjenci ze schyłkową niewydolnością nerek wyróżniają się kilkoma czynnikami, takimi jak: przeciążenie płynami, anemia, immunosupresja, zwapnienie pozakostne, niedożywienie, zaburzenia równowagi elektrolitowej i zaburzenia kwasowo-zasadowe pośrednio oddziałujące na płuca. Zgłaszamy niepowodzenie NIV u dwóch pacjentów z COVID 19 podczas dializy. Obaj pacjenci byli stabilni na NIV przed rozpoczęciem dializy lecz ulegli desaturacji, wymagając przejścia na inwazyjną wentylację mechaniczną podczas hemodializy. Możliwym mechanizmem desaturacji jest hipowentylacja pęcherzykowa przy braku hiperkapnii, która może być spowodowane usunięciem CO2 z organizmu inną drogą (dializat) niż płuca.
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