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

Kwizera, A; Kabatooro, D; Atumanya, P; Tumukunde, J; Kalungi, J; Mwanje, AK; Obua, D; Agaba, P; Sendagire, C; Nakibuuka, J; Owachi, D; Dünser, MW; Alenyo-Ngabirano, A; Olaro, C; Kyobe-Bosa, H; Kirenga, BJ; Nakiyingi, L; Kiwanuka, N; Kateete, DP; Joloba, M; Sewankambo, N; Summers, C

doi:10.1016/j.chest.2023.01.039

Respiratory failure & ventilation

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

ChestPublished 10 Feb 2023Prospective observational study

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Authors' conclusion

SOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda.

Study context

Population: Adults with COVID-19-associated ARDS at 13 Ugandan hospitals during the pandemic
Participants: 499 adults · 13 hospitals

Exposure: Respiratory support techniques: SOX, high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV)
Outcome: Respiratory support technique used, first-line (most advanced)

Methodological detailsmulticentre

Multicentre

Main finding

As reported in the abstract

SOX

37.3%

35.3%

HFNO

10%

9.4%

CPAP

11.6%

4.8%

NIV

23.4%

14.4%

IMV

17.6%

36.6%

First-line respiratory support escalated: 19.8%

Observational data: associations, not effects.

Further findings

Independent risk factors for death (logistic regression)

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Oxygen saturation to FiO2 ratio at admission	0.050.21520	0.99 (0.98–0.99)	P < 0.001
Respiratory rate at admission	0.050.21520	1.07 (1.03–1.12)	P = 0.002
NIV use	0.050.21520	6.31 (2.29–17.37)	P < 0.001
IMV use	0.050.21520	8.08 (3.52–18.57)	P < 0.001
	0.050.21520Odds ratio (log scale)

Outcome	Mortality	P value
Proning and mortalityProning vs No proning · 79 patients (15.8%) proned; 59 of 79 awake	40.5% vs 54%	P = 0.03

28-day mortality by ARDS severity

Overall: 51.9%
Mild ARDS: 13.1%
Moderate ARDS: 62.3%
Severe ARDS: 75.7%

P < .001

28-day mortality by respiratory support technique

Standard oxygen therapy (SOX): 19.9%
HFNO: 31.9%
CPAP: 58.3%
NIV: 61.1%
Invasive mechanical ventilation (IMV): 83.9%

P < .001

Escalation of first-line respiratory support

Escalated: 19.8%

Original publication

Respiratory Support Techniques for COVID-19-Related ARDS in a Sub-Saharan African Country: A Multicenter Observational Study. Chest. Published 10 February 2023. doi:10.1016/j.chest.2023.01.039

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