Thread by @VTA_Symposium

Next up in Prof Guy Richards @ProfGuyRichards who will be talking about Ventilatory Lessons Learnt from COVID. #VTA23

In SA, large numbers of patients who would normally be admitted to ICU for ventilation were instead given support through CPAP and HFNC in wards (and sometimes parking lots...) because of resource limitations. #VTA23

An SA study (n=293) with patients with a mean PF ratio of 68 who were given HFNC, had 47% of patients who survived to weaning. If HFNC failed, you had a risk of mortality of 92%! Predictors of success included a ROX-6 score of >4.4. #VTA23

CPAP, which suffers from patient intolerance, had some early failures - a study showed using normal nasal prongs vs CPAP resulted in no difference in mortality. #VTA23

However, helmet NIV may reduce mortality (RR 0.56) and intubation (0.45) in both hypoxaemic and hypercapneic patients. #VTA23

In conclusion, these devices (CPAP, NIV and HFNC) were used to reduced ICU demand. #VTA23
doi.org/10.1001/jama.2…

What about the ventilatory strategies used in these patients:
Low Volume tidal ventilation (±6ml/kg of IBW), with a Pplat =< 30cmH20 and Driving Pressure =< 15cmH20. #VTA23

There was also the advent of awake proning. Early data from COVID showed that this slightly reduced the progression to the need for intubation. A later more pragmatic trial showed no benefit. This may be because patients were reluctant to stay prone for the required period.#VTA23

Proning during MV was not associated with improvement in survival itself, however if there was a response in the PF ratio to proning, it indicated the patient was more likely to survive! #VTA23

Regarding timing of intubation, recent data showed that very early intubation and late intubation were shown to be associated with increased mortality.
#VTA23
doi.org/10.1186/s12871…

The advent of a permissive hypoxaemic strategy also came to the fore during COVID. Targets had to be altered beyond what we were often comfortable with. #VTA23

For those interested, the ROX-6 index was the ROX score (SpO2 x RR / FiO2) at 6hours post initiation of the oxygenation modality. #VTA23

All the above was cited, although I was unable to catch all the citations! #VTA23 I'm sure @ProfGuyRichards will be happy to share any references if asked! Thanks for a great talk Prof, and sorry for what I missed!