Surveillance and monitoring of patients with respiratory failure before or afterundergoing mechanical ventilation is an underdeveloped area compared to the manypossibilities of monitoring other non-invasive vital signs that we currently have.Severe respiratory failure usually affects oxygenation and ventilation. Continuous orfrequent non-invasive monitoring of oxygenation is performed with pulse oximetry, with amargin of error between 1 and 4% of arterial oxygen saturation of hemoglobin. Ventilationcannot be fully monitored in non-intubated patients: Measurement of respiratory rate (RR)outside the Intensive Care Unit (ICU) is usually performed intermittently and manually bythe nurse, often with a wide margin of error and, regarding tidal volume (VT), it cannotcurrently be monitored either directly or indirectly in non-intubated patients becausethe measurement itself interferes with respiration. Similarly, data on inspiratory andexpiratory flows cannot be obtained, which are also altered in certain pathologies. Thetechnique considered as a "gold standard" is spirometry, which requires the collaborationof the patient, and the interpretation of the results depends on the performance of thetechnique in a standardized way. Spirometry offers a single value; continuous monitoringis not feasible and due to the bias of the technique.More studies are needed to rule out the existence of different breathing patterns ofacute respiratory failure and to identify outcome differences between them beforerecommending different support or treatment approaches.In a preliminary not published study conducted with healthy volunteers, a goodcorrelation was observed between changes in temperature inside the Venturi mask using twoTSC50 thermistors and breathing pattern recorded by thoracic and abdominalplethysmographic bands.HYPOTHESES: Monitoring respiratory activity, including both RR and the respiratorypattern (tidal volume, inspiratory flow, and the inspiration-to-expiration ratio), couldenable early detection of respiratory patterns associated with the worsening of patientswith COVID-19 pneumonia and severe pneumonia of other origins.OBJECTIVESMain Objective:To evaluate the ability of the respiratory pattern to early detect respiratorydeterioration in patients hospitalized pneumonia before requiring mechanical ventilation.Specific Objectives:To describe the initial respiratory pattern and its evolution throughout the hospitalstay of patients with acute respiratory failure caused by SARS-CoV-2.To describe the evolution of the respiratory pattern in patients with bacterial pneumoniaadmitted to the hospital who require supplemental oxygen.
Not Provided
Device: Temperature sensors located in the Venturi mask, placed around the nose and mouth
Temperature sensors from the SC50 series were used, with a single use for each patient.
The signals from these sensors were recorded in the supine position with the head
elevated at 30º, if possible while the patient was at rest and silent. Simultaneous
recordings were be made using the BIOPAC MP 160 system with general-purpose amplifiers
(DA 100C).
Inclusion Criteria:
- Confirmed diagnosis of COVID-19 pneumonia, community-acquired or hospital-acquired
with moderate, severe, or critical severity criteria as defined by the World Health
Organization, OR Diagnosis of presumably bacterial pneumonia FINE III, IV or V
- Requirement for oxygen supplementation to achieve oxygen saturation (SpO2) greater
than 92%
- Signed informed consent.
Exclusion Criteria:
- Non-invasive ventilation or mechanical ventilation at the time of evaluation
- Chronic noninvasive ventilation or oxygen therapy
- Inclusion in experimental treatment studies where the administered treatment is
unknown
- Other more plausible cause of acute respiratory failure (ARF)
Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral
Sant Joan Despí, Barcelona, Spain
Not Provided