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Influenza Other Respir Viruses. 2019 Jul;13(4):382-390. doi: 10.1111/irv.12635. Epub 2019 Mar 18.

Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome.

Author information

1
Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
2
Department of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
3
Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
4
Prince Sultan Military Medical City, Military Medical Services, Ministry of Defense, Riyadh, Saudi Arabia.
5
Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
6
Department of Intensive Care, Dr. Sulaiman Al-Habib Group Hospitals, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
7
Department of Critical Care, Ohoud Hospitals, King Fahad Hospital, Al-Madinah Al-Monawarah, Saudi Arabia.
8
Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.
9
Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia.
10
Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada.
11
Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
12
King Saud University, Riyadh, Saudi Arabia.
13
Department of Anesthesiology, Intensive Care, Tanta University Hospitals, Tanta, Egypt.
14
Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia.
15
King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
16
Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia.
17
Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia.
18
Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia.
19
Infection Prevention and Control Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
20
Intensive Care Department, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
21
Infectious Diseases Data Observatory, Churchill Hospital, Oxford University, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Headington, UK.
22
Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), Charlottesville, Virginia.
23
Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.

Abstract

BACKGROUND:

Noninvasive ventilation (NIV) has been used in patients with the Middle East respiratory syndrome (MERS) with acute hypoxemic respiratory failure, but the effectiveness of this approach has not been studied.

METHODS:

Patients with MERS from 14 Saudi Arabian centers were included in this analysis. Patients who were initially managed with NIV were compared to patients who were managed only with invasive mechanical ventilation (invasive MV).

RESULTS:

Of 302 MERS critically ill patients, NIV was used initially in 105 (35%) patients, whereas 197 (65%) patients were only managed with invasive MV. Patients who were managed with NIV initially had lower baseline SOFA score and less extensive infiltrates on chest radiograph compared with patients managed with invasive MV. The vast majority (92.4%) of patients who were managed initially with NIV required intubation and invasive mechanical ventilation, and were more likely to require inhaled nitric oxide compared to those who were managed initially with invasive MV. ICU and hospital length of stay were similar between NIV patients and invasive MV patients. The use of NIV was not independently associated with 90-day mortality (propensity score-adjusted odds ratio 0.61, 95% CI [0.23, 1.60] P = 0.27).

CONCLUSIONS:

In patients with MERS and acute hypoxemic respiratory failure, NIV failure was very high. The use of NIV was not associated with improved outcomes.

KEYWORDS:

Middle East respiratory syndrome; Saudi Arabia; acute respiratory distress syndrome; coronavirus; noninvasive ventilation; pneumonia; severe acute respiratory infection

PMID:
30884185
PMCID:
PMC6586182
DOI:
10.1111/irv.12635
[Indexed for MEDLINE]
Free PMC Article

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