Factors Affecting Emergency Room Ventilator Use in COVID-19 Patients

There are different types of ventilators, each providing different levels of respiratory support. The type a doctor uses depends on the patient’s condition.

The noninvasive face mask ventilator fits over the nose and mouth of the patient while air blows into their airways and lungs. The nasal cannula is a flexible tubing that sits inside the nostrils and delivers a steady flow of heated and humidified oxygen to support a patient’s breathing.

Mechanical ventilators are machines that take over the breathing process entirely. This involves an invasive process in which a tube is inserted in the patient’s throat to pump air into the lungs and transport carbon dioxide away. Doctors use mechanical ventilators when a patient cannot breathe on their own.

A recent study examined the effect of emergency department-specific factors, such as work load and patient volume, on the use of noninvasive versus invasive respiratory support in patients with severe COVID-19.

Researchers found that COVID-19 patients with more severe illness and underlying lung disease had a higher risk of requiring invasive mechanical ventilation compared to low-flow oxygen. Older patients attended to in the emergency room had a lower risk of being on invasive mechanical ventilation compared to low-flow oxygen. As the work load of the emergency room staff increased, the odds for patients to be managed initially with noninvasive ventilation or high-flow nasal cannula (HFNC) prior to invasive mechanical ventilation increased 6- to 8-fold.

The researchers concluded that the busier the emergency department is, the higher the odds of COVID-19 patients being put on HFNC and noninvasive ventilation prior to invasive mechanical ventilation.

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