Abstract
In some patients with COVID – 19 caused ARDS, the symptoms of respiratory failure preserv iven with adequate oxygenation. Forced breathing due to "air hunger" can lead to Patient self-inflicted lung injury. Correction of the "air hunger" by increasing the support pressure leads to an increased risk of lung damage and air leakage syndrome. An alternative may be pharmacological reduction of respiratory drive.
Methods: The two-center randomized cohort study included 79 patients with nasal swab PCR confirmed COVID-19. All patients were treated with NIV and had “air hunger” and SaO2> 80 mm Hg.
Group 1 - 40 patients. Respiratory overdrive was corrected by increasing the pressure support by 2 cm H2O every 5 minutes to the correction of "air hunger".
Group 2 - 39 patients. IV morphine boluses 5 mg were obtained to reduce respiratory drive.
The results: there were no statistical differences in age, gender and comorbidities of the group. Indicators of respiratory mechanics are presented in table 1.
|
Group 1 |
Group 2 |
| Ve, ml/kg |
12.2 [11.4 – 13.0] |
6.67 [6.04 – 7.29] |
| MV, l/min |
20.9 [19.9 – 21.8] |
12.6 [11.4 – 13.8] |
| PS, mbar |
13.2 [12.3 – 14.0] |
4.17 [3.7 – 4.6] |
| FiO2 |
0.73 [0.67 – 0.79] |
0.71 [0.64 – 0.78] |
The frequency of failures and complications of respiratory support are presented in table 2.
|
Group 1 |
Group 2 |
| NIV failure |
9 |
4 |
| Subcutaneous emphysema |
10 |
2 |
| Pneumothorax |
6 |
1 |
OR of NIV failure was 0.39 [CI 0.11 - 1.4], OR of subcutaneous emphysema 6.17 [CI 1.25 - 30.32] and OR of pneumothorax 6.70 [CI 0.79 - 58.56].
Conclusions: pharmacological reduction of respiratory owerdrive reduces the likelihood of respiratory complications in patients with COVID-19-induced ARDS.