People with chronic obstructive pulmonary disease frequently seek care for acute exacerbations, which are associated with significant morbidity and mortality. Therefore, it is crucial for physicians to understand how to assess and treat these patients appropriately.
A multicenter, randomized clinical trial of 641 adults deemed ready for weaning after at least 24 hours of mechanical ventilation revealed that the use of high-flow nasal oxygen (HFNO) with noninvasive ventilation immediately after extubation significantly decreased the risk of reintubation compared to HFNO alone in mechanically ventilated patients who were at high risk of extubation failure.
In this group of patients hospitalized with severe COVID-19, the majority of whom required invasive ventilation, 68% showed clinical improvement after treatment with remdesivir on a compassionate-use basis.
COVID-19 is a systemic disease that primarily injures the vascular endothelium, causing a unique lung injury in which different management strategies may need to be considered to address the specific physiology of each patient.
While there is no consensus on the issue, there are physicians from the frontlines in New York who now favor performing more noninvasive ventilation. Some are trying to avoid using a ventilator at all.
In a randomized clinical trial of 1,153 adults who were ready for weaning after at least 24 hours of mechanical ventilation, researchers found that a spontaneous breathing trial with 30 minutes of pressure support ventilation compared with two hours of T-piece ventilation led to significantly higher successful extubation rates.