Background: Noninvasive ventilation (NIV) represents an effective treatment for chronic respiratory failure. However, empirically determined NIV settings may not achieve optimal ventilatory support. Therefore, the efficacy of NIV should be systematically monitored. The minimal recommended monitoring strategy includes clinical assessment, arterial blood gases (ABG) and nocturnal transcutaneous pulsed oxygen saturation (SpO₂). Polysomnography is a theoretical gold standard but is not routinely available in many centers. Simple tools such as transcutaneous capnography (TcPCO₂) or ventilator built-in software provide reliable informations but their role in NIV monitoring has yet to be defined. The aim of our work was to compare the accuracy of different combinations of tests to assess NIV efficacy.Methods: This retrospective comparative study evaluated the efficacy of NIV in consecutive patients through four strategies (A, B, C and D) using four different tools in various combinations. These tools included morning ABG, nocturnal SpO₂, TcPCO₂and data provided by built-in software via a dedicated module. Strategy A (ABG + nocturnal SpO₂), B (nocturnal SpO₂ + TcPCO₂) and C (TcPCO₂ + builtin software) were compared to strategy D, which combined all four tools (NIV was appropriate if all four tools were normal).Results: NIV was appropriate in only 29 of the 100 included patients. Strategy A considered 53 patients as appropriately ventilated. Strategy B considered 48 patients as appropriately ventilated. Strategy C misclassified only 6 patients with daytime hypercapnia.Conclusion: Monitoring ABG and nocturnal SpO₂is not enough to assess NIV efficacy. Combining data from ventilator built-in software and TcPCO₂seems to represent the best strategy to detect poor NIV efficacy.TrialregistrationInstitutional Review Board of the Société de Pneumologie de Langue Française (CEPRO 2016 Georges)

Backgrounds: To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods: The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results: One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ_25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p < 0.001). MV differences between ASV-F (p = 0.002) and ASV-V (p < 0.001) were not homogenously distributed across clusters, suggesting specific cluster and ASV-algorithm interactions. Individual ASV-data suggest that the hyperventilation risk is not related to the cluster nor the ASV-monitoring type. Conclusions: Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration: The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.

We aimed to compare the mortality and comfort associated with high-flow nasal cannula oxygenation (HFNCO) and high-concentration mask (HCM) in older SARS-CoV-2 infected patients who were hospitalized in non-intensive care units. In this retrospective cohort study, we included all consecutive patients aged 75 years and older who were hospitalized for acute respiratory failure (ARF) in either an acute geriatric unit or an acute pulmonary care unit, and tested positive for SARS-CoV-2. We compared the in-hospital prognosis between patients treated with HFNCO and patients treated with HCM. To account for confounders, we created a propensity score for HFNCO, and stabilizing inverse probability of treatment weighting (SIPTW) was applied. From March 2020 to January 2021, 67 patients (median age 87 years, 41 men) were hospitalized with SARS-CoV-2-related ARF, of whom 41 (61%) received HFNCO and 26 (39%) did not. Age and comorbidities did not significantly differ in the two groups, whereas clinical presentation was more severe in the HFNCO group (NEW2 score: 8 (5–11) vs. 7 (5–8), p = 0.02, and Sp02/Fi02: 88 (98–120) vs. 117 (114–148), p = 0.03). Seven (17%) vs. two (5%) patients survived at 30 days in the HFNCO and HCM group, respectively. Overall, after SIPTW, HFNCO was significantly associated with greater survival (adjusted hazard ratio (AHR) 0.57, 95% CI 0.33–0.99; p = 0.04). HFNCO use was associated with a lower need for morphine (AHR 0.39, 95% CI 0.21–0.71; p = 0.005), but not for midazolam (AHR 0.66, 95% CI 0.37–1.19; p = 0.17). In conclusion, HFNCO use in non-intensive care units may reduce mortality and discomfort in older inpatients with SARS-CoV-2-related ARF.

First described in December 2019 in Wuhan (China), COVID-19 disease rapidly spread worldwide, constituting the biggest pandemic in the last 100 years. Even if SARS-CoV-2, the agent responsible for COVID-19, is mainly associated with pulmonary injury, evidence is growing that this virus can affect many organs, including the heart and vascular endothelial cells, and cause haemostasis, CNS, and kidney and gastrointestinal tract abnormalities that can impact in the disease course and prognosis. In fact, COVID-19 may affect almost all the organs. Hence, SARS-CoV-2 is essentially a systemic infection that can present a large number of clinical manifestations, and it is variable in distribution and severity, which means it is potentially life-threatening. The goal of this comprehensive review paper in the series is to give an overview of non-pulmonary involvement in COVID-19, with a special focus on underlying pathophysiological mechanisms and clinical presentation.