Use of a Gas-Operated Ventilator as a Noninvasive Bridging Respiratory Therapy in Critically Ill COVID-19 Patients in a Middle-Income Country

Abstract

Abstract Background During the COVID-19 pandemic, the undersupply of respiratory support devices was particularly notable and especially evident in low- and middle-income countries. As a result, many hospitals turned to alternative respiratory therapies, including the use of a gas-operated ventilator (GOV). The aim of the study was to describe the use of a GOV as a noninvasive bridging respiratory therapy in critically ill COVID-19 patients and compare clinical outcomes with the conventional respiratory therapies.Method Retrospective cohort analysis of critically ill COVID-19 patients during the first local wave of the pandemic.Results The final analysis included 204 patients, they were classified into four groups according to the type of respiratory therapy received in the first 24 hours: conventional oxygen therapy (COT), n = 28 (14%); GOV, n = 72 (35%); noninvasive ventilation (NIV), n = 49 (24%); invasive mechanical ventilation (IMV), n = 55 (27%). GOV served as noninvasive bridging respiratory therapy in 58% of patients. In the remaining 42% of patients, 28% presented favorable clinical improvement and were discharged and 14% died. In the COT group, 68% progressed to intubation vs. 39% in the GOV group (P ≤ 0.001). Clinical outcomes in the GOV and NIV groups were similar (no statistically significant differences).Conclusion GOV was successfully used as a noninvasive bridging respiratory therapy in more than half of the patients. All clinical outcomes in the GOV group were comparable to those observed in the NIV group. These findings support the use of GOV as an emergency, noninvasive bridging respiratory therapy. However, a large randomized clinical trial is needed to confirm these results.