P53 The role of a ‘multidisciplinary proning team’ in managing SARS-Cov-2 patients with hypoxemic respiratory failure on an acute respiratory care unit

A. Dwarakanath, S. Booth, I. Melton, E. Barrow, A. O. C. Johnson
{"title":"P53 The role of a ‘multidisciplinary proning team’ in managing SARS-Cov-2 patients with hypoxemic respiratory failure on an acute respiratory care unit","authors":"A. Dwarakanath, S. Booth, I. Melton, E. Barrow, A. O. C. Johnson","doi":"10.1136/THORAX-2020-BTSABSTRACTS.198","DOIUrl":null,"url":null,"abstract":"BackgroundEarly awake proning (EAP) in SARS-CoV-2 as an intervention outside of intensive care unit (ICU) is gaining interest but large scale studies are lacking Anticipating a significant surge in SARS-CoV-2 related admissions and to reduce the burden on ICU, we developed a dedicated ‘multidisciplinary proning team’ (MPT) consisting of respiratory physiotherapists and Acute Respiratory Care Unit (ARCU) staff who undertook this intervention MethodPatients with either suspected or confirmed SARS-CoV-2 with worsening hypoxemia (PaO2 6 5) were admitted to ARCU for consideration of respiratory support Along with the standard supportive measures, patients were also assessed for EAP and suitable patients were proned driven by patients’ preference This was led by the MPT Patient demographics, Length of stay (LOS), clinical characteristics, proning duration and outcomes between survivors and non- survivors were evaluated Results39 patients [age: mean ± SD= 63±16, males-64%] were proned on 99 sessions [median (IQR) = 2 (1–4) sessions per patient, each session lasting for 2–4 hours] The median (IQR) LOS was 5 (4–9) days Patients who survived were significantly younger as compared to those who did not survive (55 years v/s 69 years, P= 0 007) There was a significant difference in the saturations at admission (96% v/s 91%, P= 0 04;mean diff= -4 38) and Sp02 change on proning was similar between survivors and non-survivors (Δ 5%,P=0 46) Majority of patients in both the groups were managed with CPAP + PS but patients who survived required a lower supplemental fio2 as compared to those who did not survive (55% v/s 70%, P= <0 0001, mean diff= 22%) Overall proning failure was 10% and there was no difference in baseline RR, ABG measurements and specific SARS-Cov-2 blood parameters DiscussionEAP may be considered outside of ICU and a dedicated proning team may be helpful Further large scale studies are warranted to evaluate the various effects of awake proning Age at presentation and the degree of hypoxemia are vital factors when assessing and managing patients","PeriodicalId":137735,"journal":{"name":"Ventilatory strategies in COVID-19","volume":"56 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2021-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ventilatory strategies in COVID-19","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/THORAX-2020-BTSABSTRACTS.198","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

BackgroundEarly awake proning (EAP) in SARS-CoV-2 as an intervention outside of intensive care unit (ICU) is gaining interest but large scale studies are lacking Anticipating a significant surge in SARS-CoV-2 related admissions and to reduce the burden on ICU, we developed a dedicated ‘multidisciplinary proning team’ (MPT) consisting of respiratory physiotherapists and Acute Respiratory Care Unit (ARCU) staff who undertook this intervention MethodPatients with either suspected or confirmed SARS-CoV-2 with worsening hypoxemia (PaO2 6 5) were admitted to ARCU for consideration of respiratory support Along with the standard supportive measures, patients were also assessed for EAP and suitable patients were proned driven by patients’ preference This was led by the MPT Patient demographics, Length of stay (LOS), clinical characteristics, proning duration and outcomes between survivors and non- survivors were evaluated Results39 patients [age: mean ± SD= 63±16, males-64%] were proned on 99 sessions [median (IQR) = 2 (1–4) sessions per patient, each session lasting for 2–4 hours] The median (IQR) LOS was 5 (4–9) days Patients who survived were significantly younger as compared to those who did not survive (55 years v/s 69 years, P= 0 007) There was a significant difference in the saturations at admission (96% v/s 91%, P= 0 04;mean diff= -4 38) and Sp02 change on proning was similar between survivors and non-survivors (Δ 5%,P=0 46) Majority of patients in both the groups were managed with CPAP + PS but patients who survived required a lower supplemental fio2 as compared to those who did not survive (55% v/s 70%, P= <0 0001, mean diff= 22%) Overall proning failure was 10% and there was no difference in baseline RR, ABG measurements and specific SARS-Cov-2 blood parameters DiscussionEAP may be considered outside of ICU and a dedicated proning team may be helpful Further large scale studies are warranted to evaluate the various effects of awake proning Age at presentation and the degree of hypoxemia are vital factors when assessing and managing patients
“多学科应急团队”在急性呼吸监护室管理低氧性呼吸衰竭的SARS-Cov-2患者中的作用
背景:在重症监护病房(ICU)外,对SARS-CoV-2进行清醒治疗(EAP)作为一种干预措施正在引起人们的兴趣,但缺乏大规模的研究。我们建立了一个专门的“多学科预防小组”(MPT),由呼吸物理治疗师和急性呼吸护理单位(ARCU)的工作人员组成,他们进行了这项干预。方法疑似或确诊的SARS-CoV-2低氧血症(PaO2 65)恶化的患者被送入ARCU,考虑呼吸支持以及标准的支持措施。对患者的EAP进行评估,并根据患者的偏好选择合适的患者。这是由MPT主导的。患者人口统计学、住院时间(LOS)、临床特征、治疗持续时间和幸存者与非幸存者之间的结局进行评估。平均±SD= 63±16,男性占64%],随访99次[中位(IQR) = 2(1-4)次/患者,每次持续2 - 4小时],中位(IQR) LOS为5(4-9)天,存活的患者明显比不存活的患者年轻(55岁vs 69岁,P= 0.007),入院时饱和度差异显著(96% vs 91%,P= 0.04;mean diff= - 4.38)和Sp02变化在幸存者和非幸存者之间相似(Δ 5%,P= 0.46)两组中的大多数患者均采用CPAP + PS治疗,但存活的患者与未存活的患者相比需要更低的补充fio2 (55% v/s 70%, P= < 0.0001, mean diff= 22%)总体proning失败率为10%,基线RR无差异。ABG测量和特定的SARS-Cov-2血液参数讨论可考虑在ICU外进行ap,并且专门的俯卧团队可能会有所帮助,进一步的大规模研究有必要评估清醒俯卧的各种影响,就诊时年龄和低氧血症程度是评估和管理患者时的重要因素
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信