NON-INVASIVE VENTILATION IN A CRITICALLY ILL PATIENT WITH COVID-19 PNEUMONIA

Abstract

Hypoxaemic respiratory failure due to COVID-19 is difficult to manage because the optimal timing of intubation is uncertain. Delayed intubation in patients who are indicated for ventilatory support results in higher morbidity and mortality. The use of non-invasive ventilation (NIV) in COVID 19 is still debatable. We present a case of a patient with COVID-19 who was successfully weaned from NIV and discharged home. A 60-year-old woman with diabetes and hypertension was admitted to the COVID-19 ward. She had had contact with her husband, who had fever and cough for 10 days at home. On day one of her admission, she was diagnosed with COVID-19 by real-time PCR, which was day 12 of her illness’. She had been asymptomatic prior to hospitalisation. She became tachypnoeic on day 4 of admission, and a chest radiograph revealed worsening heterogenous opacities. She required a gradual increase in oxygen supplementation due to progressive hypoxaemic respiratory failure from day 4 until day 9 of admission. She was first treated in the prone position with nasal prong oxygen before being treated with an NIV nasal mask in an isolation room from day 5 until day 10 of admission. She required fraction of inspired oxygen (FiO₂) in the range 40–60% with positive end-expiratory pressure (PEEP) of 6–8 cm H₂0, pressure support 4–6 cm H₂0 above PEEP and tidal volume 6–7 ml/kg body weight. Her lowest partial pressure of oxygen (PaO₂) was 57 mmHg under 60% FiO₂while on NIV. Her PaO₂/FiO₂ ratio was 95. She was given favipiravir, intravenous methylprednisolone, subcutaneous enoxaparin, tocilizumab and empirical antibiotic meropenem. She was discharged well after 10 days of hospitalisation. NIV is useful in selected cases of patients who require increasing oxygen supplementation. Judicious use of NIV in patients with COVID-19 prevents the patient having to undergo intubation and the complications of invasive mechanical ventilation.