Effectiveness of non-invasive ventilation in acute respiratory failure by Covid-19 at Befelatanana hospital Antananarivo - 17/02/23

Non-invasive ventilation can be used for the management of acute respiratory distress syndrome in Covid-19 patients. The objective of our study is to describe the profile of severe covid-19 patients with non-invasive ventilation seen in the Joseph Raseta Befelatanana University Hospital in Antananarivo, Madagascar.

This was a descriptive prospective observational study from April 1 to June 30, 2021, including all confirmed cases of Covid-19 by RT-PCR, severe form whose Sa02/Fi02 ratio is≤315 whose non-invasive ventilation was the ventilation support used. Non-invasive ventilation parameters: Fi02 for Sp02≥92%; EPAP 4–8cmH20; pressure support: 5–12cmH20 for tidal volume target: 6–8mL/kg of ideal weight; continuous session. The parameters studied were demographic, clinical, imaging, therapeutic and outcomes. Non-invasive ventilation failure was defined as patient death.

During this period, 09 cases were retained. The average age was 63 years old. A male predominance was found with a sex ratio of 2. Eighty-nine percent (89%) of the cases had comorbidities dominated by high blood pressure (67%) and diabetes (33%). One case had known COPD (11%). Imaging was typical in CT scan with ground glass (100%), condensation (44%), fibrosis (33%), both peripheral and central (78%), diffuse (100%), bilateral (100%); affecting more than 50% (66%) of the lung parenchyma. Non-invasive ventilation was well tolerated in 67% of cases. Non-invasive ventilation was effective in 67% of cases by decreasing respiratory rate (89%), signs of respiratory struggle (56%) and improving hypoxemia (100%). The duration of a session ranged from 12 to 20hours per 24hours. The average total duration of non-invasive ventilation was 5 days ranging from 1 to 11 days. The healing rate was 67% although 83% were discharged with long-term oxygenotherapy and 17% with home non-invasive ventilation. Nevertheless, the death rate was 33.33%.

The occurrence of acute respiratory distress syndrome constitutes the severity of covid-19. Non-invasive ventilation is an alternative to reduce the mortality of patients with acute respiratory distress syndrome.