Parameters predicting non-invasive ventilation failure in COVID-19 patients
Introduction
During COVID-19 pandemic, non-invasive ventilation (NIV) was widely used during COVID-19 Pandemic. The factors predicting NIV failure in COVID-19 patients remain debatable. The goal of this research is to identify the parameters that may correlate NIV failure.
Materials and methods
A retrospective analysis of COVID-19 patients’ data, who were admitted to ICU of the Institute of Emergency Medicine, Chisinau, during July-October 2020 and connected to NIV. The study analyzed the demographics, laboratory and respiratory parameters (at admission, at NIV initiation, 24-48h and 72-96h of NIV) and their relation with NIV failure. For continuous variables, the established confidence interval was 95%. The Kruskal-Wallis H test was used for continuous variables and the Fisher’s exact test or chi-squared test was used for category data.
Results
In study were included 154 patients. NIV failed in 52 patients. In NIV failure group were registered a higher rate of hypertension (88% vs 74%, p = 0.033), delirium (60% vs 20%, p=0.001) and need for sedation (83% vs 48, p=0.001). The urea levels were lower in NIV success group at admission, at NIV initiation and at 24-48h of NIV. The neutrophil/ lymphocyte ratio was higher in NIV failure group at NIV initiation; at 24-48h and 72-96h of NIV. NIV failure group had a higher level of WBC count and C-reactive protein at 24-48h and 72-96h as well as D-dimer at 72-96h of NIV. The ROX index was higher in NIV success group from NIV initiation and through 72h of NIV.
Conclusions
The presence of abnormal values of neutrophil/lymphocyte ratio, urea, lymphocytes, WBC count, C-reactive protein, D-dimer and ROX index during non-invasive ventilation, as well as association of delirium and need for sedation, can be suggestive and informative for high risk of NIV failure in COVID-19 patients. Continuous measurement of these parameters may help the clinicians to decide the optimal timing of conversion to invasive ventilation.
Hypotension in spinal anesthesia: predictive factors, prevention and volemia's non-invasive estimation methods
Introduction
Evaluation of patient volemia arriving at a medical service today still represents a challenge for specialists, especially in those who need surgical and anesthetic intervention. One of the most common systemic side effect to anesthesia is hypotension. Spinal Anesthesia-Induced Hypotension (SAIH) because of sympathetic blockade is most frequently cited as a complication of subarachnoid anesthesia, its severity being influenced by the patient's volemic state. The aim of this literature review is to analyze if „routine” preanesthetic preloading reduces the incidence of SAIH in patients undergoing spinal anesthesia, also to emphasize the efficacy of preanesthetic assessment of the IVC/Ao (Inferior Vena Cava/Abdominal Aorta) Index measured by ultrasound in determination of patients’ volemia.
Material and methods
Narrative literature review. Bibliographic search in the PubMed, NCBI and Google Academic databases, using the keywords: „hypotension inferior vena cava”, „hypotension spinal anesthesia”, „inferior vena cava/aorta diameter”, „preloading hypotension”, which were combined with each other. The final bibliography included 40 references.
Results
The principles of perianesthetic volemia management and prevention of arterial hypotension after the administration of the spinal block were detected in different groups of patients: the elderly, adult patients, anesthesiologic assistance in obstetrics and in various types of surgical interventions. Hypotension incidence data in patients with and without preanesthetic volume repletion were detected. At the same time, the effectiveness of the ultrasonographic assessment of IVC/Ao index in assessing patient's volume status was determined. The information was analyzed and synthesized in the article.
Conclusions
The effectiveness of routine preloading in reducing the incidence of arterial hypotension after spinal anesthesia did not prove its benefits in normovolemic patients, and ultrasonographic assessment of the IVC/Ao Index in assessing the volume status appears to be a simple, rapid, non-invasive, cost-effective volume assessment, which does not require the presence of a specialized imagist, being practically devoid of contraindications.