Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Aug;164(2):369-380.
doi: 10.1016/j.chest.2023.01.039. Epub 2023 Feb 10.

Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study

Arthur Kwizera  1 , Daphne Kabatooro  2 , Patience Atumanya  2 , Janat Tumukunde  2 , Joyce Kalungi  2 , Arthur Kavuma Mwanje  2 , Daniel Obua  2 , Peter Agaba  2 , Cornelius Sendagire  3 , Jane Nakibuuka  4 , Darius Owachi  5 , Martin W Dünser  6 , Anne Alenyo-Ngabirano  7 , Charles Olaro  7 , Henry Kyobe-Bosa  8 , Bruce J Kirenga  9 , Lydia Nakiyingi  10 , Noah Kiwanuka  11 , David Patrick Kateete  12 , Moses Joloba  12 , Nelson Sewankambo  10 , Charlotte Summers  13
Affiliations
Observational Study

Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study

Arthur Kwizera et al. Chest. 2023 Aug.

Abstract

Background: Limited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS.

Research question: Which respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda?

Study design and methods: A multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded. Standard tests, log-rank tests, and logistic regression analyses were used for statistical analyses.

Results: Four hundred ninety-nine patients with COVID-19-associated ARDS (mild, n = 137; moderate, n = 247; and severe, n = 115) were included (ICU admission, 38.9%). Standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) was used as the first-line (most advanced) respiratory support technique in 37.3% (35.3%), 10% (9.4%), 11.6% (4.8%), 23.4% (14.4%), and 17.6% (36.6%) of patients, respectively. The first-line respiratory support technique was escalated in 19.8% of patients. Twenty-eight-day mortality was 51.9% (mild ARDS, 13.1%; moderate ARDS, 62.3%; severe ARDS, 75.7%; P < .001) and was associated with respiratory support techniques as follows: SOX, 19.9%; HFNO, 31.9%; CPAP, 58.3%; NIV 61.1%; and IMV, 83.9% (P < .001). Proning was used in 79 patients (15.8%; 59 of 79 awake) and was associated with lower mortality (40.5% vs 54%; P = .03). The oxygen saturation to Fio2 ratio (OR, 0.99; 95% CI, 0.98-0.99; P < .001) and respiratory rate (OR, 1.07; 95% CI, 1.03-1.12; P = .002) at admission and NIV (OR, 6.31; 95% CI, 2.29-17.37; P < .001) or IMV (OR, 8.08; 95% CI, 3.52-18.57; P < .001) use were independent risk factors for death.

Interpretation: SOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda. Although these data are observational, they suggest that the use of SOX and HFNO therapy as well as awake proning are associated with a lower mortality resulting from COVID-19-associated ARDS in a resource-limited setting.

Keywords: ARDS; COVID-19; Uganda; respiratory support technique; sub-Saharan Africa.

PubMed Disclaimer

Conflict of interest statement

Financial/Nonfinancial Disclosures None declared.

Figures

Figure 1
Figure 1
Study flow diagram. AHRF = acute hypoxemic respiratory failure.
Figure 2
Figure 2
Flow diagram showing respiratory therapy techniques and escalation pathways in patients with COVID-19 ARDS. HFNO = high-flow nasal oxygen; IMV = invasive mechanical ventilation; NIV = noninvasive ventilation; SOX = standard oxygen therapy.
Figure 3
Figure 3
Kaplan-Meier curves showing survival by respiratory strategy. HFNO = high-flow nasal oxygen; IMV = invasive mechanical ventilation; LOS = legnth of stay; NIV = noninvasive ventilation; SOX = standard oxygen therapy.
Figure 4
Figure 4
Kaplan-Meier curves showing survival by proning strategy. LOS = length of stay.
See this image and copyright information in PMC

Comment in

References

    1. Li Q., Guan X., Wu P., et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199–1207. - PMC - PubMed
    1. COVIS-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2021;47(1):60–73. - PMC - PubMed
    1. Nasa P., Azoulay E., Khanna A.K., et al. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Crit Care. 2021;25(1):106. - PMC - PubMed
    1. Alhazzani W., Evans L., Alshamsi F., et al. Surviving Sepsis Campaign guidelines on the management of adults with coronavirus disease 2019 (COVID-19) in the ICU: first update. Crit Care Med. 2021;49(3):e219–e234. - PubMed
    1. Rochwerg B., Granton D., Wang D.X., et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Med. 2019;45(5):563–572. - PubMed

Publication types

MeSH terms