Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia

COVID-19; High-flow nasal cannula; PneumoniaCOVID-19; Cánula nasal de alto flujo; NeumoníaCOVID-19; Cànula nasal d'alt flux; PneumòniaThe use of non-invasive respiratory strategies (NIRS) is crucial to improve oxygenation in COVID-19 patients with hypoxemia refractory to conventional oxygen therapy. However, the absence of respiratory symptoms may delay the start of NIRS. The aim of this study was to determine whether a simple bedside test such as single-breath counting test (SBCT) can predict the need for NIRS in the 24 h following the access to Emergency Department (ED). We performed a prospective observational study on 120 patients with COVID-19 pneumonia. ROC curves were used to analyze factors which might predict NIRS requirement. We found that 36% of patients had normal respiratory rate and did not experience dyspnea at rest. 65% of study population required NIRS in the 24 h following the access to ED. NIRS-requiring group presented lower PaO2/FiO2 (235.09 vs. 299.02), SpO2/FiO2 ratio (357.83 vs. 431.07), PaCO2 (35.12 vs. 40.08), and SBCT (24.46 vs. 30.36) and showed higher incidence of dyspnea at rest (57.7% vs. 28.6%). Furthermore, SBCT predicted NIRS requirement even in the subgroup of patients without respiratory symptoms (AUC = 0.882, cut-off = 30). SBCT might be a valuable tool for bedside assessment of respiratory function in patients with COVID-19 pneumonia and might be considered as an early clinical sign of impending respiratory deterioration

Brief intensive observation areas in the management of acute heart failure in elderly patients leading to high stabilisation rate and less admissions

Objectives. Acute heart failure is major cause of hospitalisation in Western countries. As patients with acute heart failure cannot be admitted directly to the wards, they stay in emergency rooms, causing access block. Brief Intensive Observation areas are holding units dedicated to the stabilisation of patients requiring close monitoring. However, these units have been associated with acute exacerbation of heart failure. This study aimed to evaluate the impact of Brief Intensive Observation areas on the management of acute heart failure in elderly patients. Methods. This retrospective, single-centred observational study analysed patients who presented in the emergency room with acute heart failure in 2017 and divided them into two cohorts: those treated in the Brief Intensive Observation and those who were not. The reduction of colour codes at discharge, mortality rate within the emergency rooms, hospitalisation rate, rate of transfer to less intensive facilities and readmission rate at 7, 14 and 30 days after discharge were compared. Results. Of the 694 patients, 62% were transferred to the Brief Intensive Observation for stabilisation. Age and sex between the cohorts were not significantly different. However, compared to non-Brief Intensive Observation patients, the Brief Intensive Observation patients had worse clinical conditions on arrival and longer stabilisation period. The stabilisation rate was higher in Brief Intensive Observation patients than in non-Brief Intensive Observation patients. Conclusions. Brief Intensive Observation areas allows effective stabilisation of elderly patients, better management of beds, reduced admission rates and reduced use of high intensity care unit beds

Single-Breath Counting Test Predicts Non-Invasive Respiratory Support Requirements in Patients with COVID-19 Pneumonia

The use of non-invasive respiratory strategies (NIRS) is crucial to improve oxygenation in COVID-19 patients with hypoxemia refractory to conventional oxygen therapy. However, the absence of respiratory symptoms may delay the start of NIRS. The aim of this study was to determine whether a simple bedside test such as single-breath counting test (SBCT) can predict the need for NIRS in the 24 h following the access to Emergency Department (ED). We performed a prospective observational study on 120 patients with COVID-19 pneumonia. ROC curves were used to analyze factors which might predict NIRS requirement. We found that 36% of patients had normal respiratory rate and did not experience dyspnea at rest. 65% of study population required NIRS in the 24 h following the access to ED. NIRS-requiring group presented lower PaO2/FiO2 (235.09 vs. 299.02), SpO2/FiO2 ratio (357.83 vs. 431.07), PaCO2 (35.12 vs. 40.08), and SBCT (24.46 vs. 30.36) and showed higher incidence of dyspnea at rest (57.7% vs. 28.6%). Furthermore, SBCT predicted NIRS requirement even in the subgroup of patients without respiratory symptoms (AUC = 0.882, cut-off = 30). SBCT might be a valuable tool for bedside assessment of respiratory function in patients with COVID-19 pneumonia and might be considered as an early clinical sign of impending respiratory deterioration