dr Miriam Stoppard looks at new ways to ventilate Covid patients and how clinicians are conducting studies to better understand how non-invasive respiratory support can best be used to treat them
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For patients in the intensive care unit with covid, ventilation is undoubtedly life-saving. but neither the lungs nor the body like mechanical ventilation.
A team of experts from Warwick University have found that while ventilation improves the patient’s oxygen supply, stress and strain in the lungs can reach dangerous levels if breathing effort cannot be reduced.
In an attempt to avoid the risks of mechanical ventilation, many Covid-19 patients are first treated with gentle ventilation such as continuous positive airway pressure (CPAP), high-flow nasal oxygen therapy (HFNOT) or non-invasive ventilation (NIV). Use of face masks or nasal tubes while the patient is awake and breathing spontaneously. These therapies can also be carried out outside of the intensive care unit.
We don’t know why some patients do well and improve with these noninvasive therapies, while others deteriorate and eventually need to be put on a mechanical ventilator. Clinicians around the world are conducting clinical trials to better understand how non-invasive respiratory support can best be used to treat patients.
One of the secrets of success seems to be giving patients less work. Working with an international team of leading critical care physicians, technical researchers at Warwick University have used computer modeling to show that non-invasive respiratory support is more successful when a patient’s effort to breathe is reduced.
Warwick University engineers and their international team are the first to use computer models to compare the effectiveness of conventional oxygen therapy (COT), HFNOT, CPAP and NIV.
They used computer simulations of 120 Covid-19 patients to quantify the internal mechanical forces generated by different types of respiratory support at different levels of respiratory effort.
Professor Declan Bates of Warwick’s School of Engineering comments: “Many Covid-19 patients suffering from acute respiratory failure are initially treated with some form of non-invasive respiratory support to help them breathe and avoid the need for mechanical ventilation .
“This study demonstrates the power of computer simulations to quickly answer questions directly relevant to the management of critically ill patients.”
dr Luigi Camporota, Specialist in Intensive Care Medicine at Guy’s and St Thomas’ Hospital London and co-author of the study, says: “There is concern that strenuous breathing can further damage the lungs of Covid-19 patients. Our study found that the reduction in patients’ respiratory effort after initiating noninvasive respiratory support could be a key indicator of likely success.
“These results provide much-needed evidence to help clinicians guide and optimize treatment of Covid-19 patients to avoid additional and preventable lung damage.”
This research could revolutionize ventilator treatment for Covid patients worldwide.
https://www.mirror.co.uk/news/uk-news/respiratory-breakthrough-help-covid-19-27189191 “Respiratory breakthrough will help Covid-19 patients worldwide” – Miriam Stoppard