Safety Assessment of a Noninvasive Respiratory Protocol for Adults with COVID-19
Emergency Medicine; Healthcare Quality; Medicine
As evidence emerged supporting noninvasive strategies for coronavirus disease 2019 (COVID-19)-related respiratory distress, we implemented a noninvasive COVID-19 respiratory protocol (NCRP) that encouraged high-flow nasal cannula (HFNC) and self-proning across our healthcare system. To assess safety, we conducted a retrospective chart review evaluating mortality and other patient safety outcomes after implementation of the NCRP protocol (April 3, 2020, to April 15, 2020) for adult patients hospitalized with COVID-19, compared with preimplementation outcomes (March 15, 2020, to April 2, 2020). During the study, there were 469 COVID-19 admissions. Fewer patients underwent intubation after implementation (10.7% [23 of 215]), compared with before implementation (25.2% [64 of 254]) (P < .01). Overall, 26.2% of patients died (24% before implementation vs 28.8% after implementation; P = .14). In patients without a do not resuscitate/do not intubate order prior to admission, mortality was 21.8% before implementation vs 21.9% after implementation. Overall, we found no significant increase in mortality following implementation of a noninvasive respiratory protocol that decreased intubations in patients with COVID-19.
Soares WE 3rd, Schoenfeld EM, Visintainer P, Elia T, Medarametla V, Schoenfeld DA, Deutsch A, Salvador D, Dietzen D, Tidswell MA, DePergola PA 2nd, St Marie P, Westafer LM. Safety Assessment of a Noninvasive Respiratory Protocol for Adults with COVID-19. J Hosp Med. 2020 Nov 18. doi: 10.12788/jhm.3548. Epub ahead of print.