Continuous positive airway pressure for respiratory support during COVID-19 pandemic: a frugal approach from bench to bedside

Annals of Intensive Care

Philippe Grimbert¹  Vincent Audard²  Nicolas Mongardon³  Karim Jaffal⁴  Elena Fois⁵  Keyvan Razazi⁶  Armand Mekontso Dessap⁶  François Perier⁶  Nicolas de Prost⁶  Anne-Fleur Haudebourg⁶  Samuel Tuffet⁶  Guillaume Carteaux⁶  Alain Mercat⁷  François Beloncle⁷  Arnaud Lesimple⁸  Raphaëlle Huguet⁹  Camille Deguillard⁹  Jean-Christophe Richard^1,10  François Templier^1,11  François Morin^1,11  Dominique Savary^1,12  Constance Guillaud^1,13  Mehdi Khellaf^1,14  Yvon Deplante^1,15  Manuella Pons^1,16  Frédéric Schlemmer^1,17  Pascal Lim^1,18  Laurent Brochard^1,19  Bilal Badat^2,20 

[1] Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », 94010, Créteil, France;Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service de Néphrologie et Transplantation, Centre de Référence Maladie Rare « Syndrome Néphrotique Idiopathique », 94010, Créteil, France;Université Paris Est-Créteil, INSERM, IMRB, Equipe 21, 94010, Créteil, France;Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service d’Anesthésie-Réanimation Chirurgicale, 94010, Créteil, France;Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Service d’immunologie Clinique Et Maladies Infectieuses, 94010, Créteil, France;Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Unité des Maladies Génétiques du Globule Rouge, 94010, Créteil, France;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;Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France;INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France;CNRS, INSERM 1083, MITOVASC, Université d’Angers, Angers, France;Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, Centre Hospitalier Universitaire d’Angers, Vent’ Lab, Université d’Angers, Angers, France;CNRS, INSERM 1083, MITOVASC, Université d’Angers, Angers, France;Laboratoire Med2Lab ALMS, Antony, France;Department of Cardiovascular Medicine, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France;Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Faculté de Santé, Centre Hospitalier Universitaire d’Angers, Vent’ Lab, Université d’Angers, Angers, France;INSERM, UMR 1066, Créteil, France;Département de Médecine d’Urgence, Faculté de Santé, Centre Hospitalier Universitaire d’Angers, Université d’Angers, Angers, France;Département de Médecine d’Urgence, Faculté de Santé, Centre Hospitalier Universitaire d’Angers, Université d’Angers, Angers, France;IRSET (Institut de Recherche en Santé, environnement et travail)-UMR_S 1085, 49000, Angers, France;Département d’Aval des Urgences, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France;Emergency Department, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France;Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France;Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010, Créteil, France;Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France;INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France;Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Unité de Pneumologie, 94010, Créteil, France;INSERM U955, Institut Mondor de Recherche Biomédicale, 94010, Créteil, France;Department of Cardiovascular Medicine, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, 94010, Créteil, France;Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada;Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada;Laboratoire Med2Lab ALMS, Antony, France;

关键词: COVID-19;    Acute hypoxemic respiratory failure;    Continuous positive airway pressure;    Frugal innovation;   

DOI  :  10.1186/s13613-021-00828-2

来源: Springer

【 摘 要 】

BackgroundWe 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.ResultsBench 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).ConclusionAdding 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.

【 授权许可】

CC BY