Continuous positive airway pressure for respiratory support during COVID-19 pandemic: a frugal approach from bench to bedside

Guillaume Carteaux (1, 2) , Manuella Pons (3, 4) , François Morin (5) , Samuel Tuffet (1, 2) , Arnaud Lesimple (6) , Bilal Badat , Anne-Fleur Haudebourg (1, 2) , Francois Perier (1, 2) , Yvon Deplante (1) , Constance Guillaud (2) , Frédéric Schlemmer (1, 2) , Elena Fois (2) , Nicolas Mongardon (2) , Mehdi Khellaf (7, 2) , Karim Jaffal (2) , Camille Deguillard (2) , Philippe Grimbert (2) , Raphaelle Huguet (2) , Keyvan Razazi (1, 2) , Nicolas de Prost (1, 2) , François Templier (5) , Francois Beloncle (6, 5) , Alain Mercat (6, 5) , Laurent Brochard (8, 9) , Vincent Audard (1, 2) , Pascal Lim (1, 2) , Jean-Christophe Richard (10, 11) , Dominique Savary (5, 12) , Armand Mekontso Dessap (1, 2)

1 IMRB - Institut Mondor de Recherche Biomédicale
2 CHU Henri Mondor [Créteil]
3 UPEC UP12 - Université Paris-Est Créteil Val-de-Marne - Paris 12
4 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
5 CHU Angers - Centre Hospitalier Universitaire d'Angers
6 MITOVASC - MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale
7 CHU Henri Mondor - Département de neurosciences
8 University of Toronto
9 Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto]
10 CREATIS - Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé
11 MYRIAD - Modeling & analysis for medical imaging and Diagnosis
12 Irset - Institut de recherche en santé, environnement et travail

Background We describe a frugal approach (focusing on needs, performance, and costs) to manage a massive influx of COVID-19 patients with acute hypoxemic respiratory failure (AHRF) using the Boussignac valve protected by a filter ("Filter Frugal CPAP", FF-CPAP) in and out the ICU.Methods (1) A bench study measured the impact of two filters with different mechanical properties on CPAP performances, and pressures were also measured in patients. (2) Non-ICU healthcare staff working in COVID-19 intermediate care units were trained with a video tutorial posted on a massive open online course. (3) A clinical study assessed the feasibility and safety of using FF-CPAP to maintain oxygenation and manage patients out of the ICU during a massive outbreak.Results: Bench assessments showed that adding a filter did not affect the effective pressure delivered to the patient. The resistive load induced by the filter variably increased the simulated patient's work of breathing (6-34%) needed to sustain the tidal volume, depending on the filter's resistance, respiratory mechanics and basal inspiratory effort. In patients, FF-CPAP achieved pressures similar to those obtained on the bench. The massive training tool provided precious information on the use of Boussignac FF-CPAP on COVID-19 patients. Then 85 COVID-19 patients with ICU admission criteria over a 1-month period were studied upon FF-CPAP initiation for AHRF. FF-CPAP significantly decreased respiratory rate and increased SpO(2). Thirty-six (43%) patients presented with respiratory indications for intubation prior to FF-CPAP initiation, and 13 (36%) of them improved without intubation. Overall, 31 patients (36%) improved with FF-CPAP alone and 17 patients (20%) did not require ICU admission. Patients with a respiratory rate > 32 breaths/min upon FF-CPAP initiation had a higher cumulative probability of intubation (p < 0.001 by log-rank test).Conclusion: Adding a filter to the Boussignac valve does not affect the delivered pressure but may variably increase the resistive load depending on the filter used. Clinical assessment suggests that FF-CPAP is a frugal solution to provide a ventilatory support and improve oxygenation to numerous patients suffering from AHRF in the context of a massive outbreak.

Mots clés: COVID-19; Acute hypoxemic respiratory failure; Continuous positive airway pressure; Frugal innovation

Domaines: Pneumologie et système respiratoire; Maladies infectieuses; Maladies émergentes

Guillaume Carteaux, Manuella Pons, François Morin, Samuel Tuffet, Arnaud Lesimple, et al.. Continuous positive airway pressure for respiratory support during COVID-19 pandemic: a frugal approach from bench to bedside. Annals of Intensive Care, 2021, 11 (1), pp.38. ⟨10.1186/s13613-021-00828-2⟩. ⟨hal-03215975⟩