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Optimising respiratory support for early COVID-19 pneumonia : a computational modelling study
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Weaver, Liam, Das, Anup, Saffaran, Sina, Yehya, Nadir, Chikhani, Marc, Scott, Timothy E., Laffey, John G., Hardman, Jonathan G., Camporota, Luigi and Bates, Declan G. (2022) Optimising respiratory support for early COVID-19 pneumonia : a computational modelling study. British Journal of Anaesthesia, 128 (6). pp. 1052-1058. doi:10.1016/j.bja.2022.02.037 ISSN 0007-0912.
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WRAP-Optimising-respiratory-COVID-19-pneumonia-study-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (1761Kb) | Preview |
Official URL: https://doi.org/10.1016/j.bja.2022.02.037
Abstract
Optimal respiratory support in early COVID-19 pneumonia is controversial and remains unclear. Using computational modelling, we examined whether lung injury might be exacerbated in early COVID-19 by assessing the impact of conventional oxygen therapy (COT), high-flow nasal oxygen therapy (HFNOT), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV). Using an established multi-compartmental cardiopulmonary simulator, we first modelled COT at a fixed FiO (0.6) with elevated respiratory effort for 30 min in 120 spontaneously breathing patients, before initiating HFNOT, CPAP, or NIV. Respiratory effort was then reduced progressively over 30-min intervals. Oxygenation, respiratory effort, and lung stress/strain were quantified. Lung-protective mechanical ventilation was also simulated in the same cohort. HFNOT, CPAP, and NIV improved oxygenation compared with conventional therapy, but also initially increased total lung stress and strain. Improved oxygenation with CPAP reduced respiratory effort but lung stress/strain remained elevated for CPAP >5 cm H O. With reduced respiratory effort, HFNOT maintained better oxygenation and reduced total lung stress, with no increase in total lung strain. Compared with 10 cm H O PEEP, 4 cm H O PEEP in NIV reduced total lung stress, but high total lung strain persisted even with less respiratory effort. Lung-protective mechanical ventilation improved oxygenation while minimising lung injury. The failure of noninvasive ventilatory support to reduce respiratory effort may exacerbate pulmonary injury in patients with early COVID-19 pneumonia. HFNOT reduces lung strain and achieves similar oxygenation to CPAP/NIV. Invasive mechanical ventilation may be less injurious than noninvasive support in patients with high respiratory effort.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine |
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| Divisions: | Faculty of Science, Engineering and Medicine > Engineering > Engineering | |||||||||
| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Respiratory distress syndrome, Adult -- Treatment, COVID-19 (Disease) -- Patients -- Treatment, Artificial respiration, Oxygen therapy, Intermittent positive pressure breathing | |||||||||
| Journal or Publication Title: | British Journal of Anaesthesia | |||||||||
| Publisher: | Oxford University Press | |||||||||
| ISSN: | 0007-0912 | |||||||||
| Official Date: | 1 June 2022 | |||||||||
| Dates: |
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| Volume: | 128 | |||||||||
| Number: | 6 | |||||||||
| Page Range: | pp. 1052-1058 | |||||||||
| DOI: | 10.1016/j.bja.2022.02.037 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 6 May 2022 | |||||||||
| Date of first compliant Open Access: | 6 May 2022 | |||||||||
| RIOXX Funder/Project Grant: |
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