SuperNO2VA in COVID-19 critical ill patients. An alternative for non-invasive respiratoryort.

Abstract

Coronavirus disease 2019 (COVID-19) was known at the end of last year,  initially in the Wuhan province of China, but it spread quickly throughout the world and in February 2020 it was already present in several countries on all continents; in mild-March the world health organization (WHO) officially declared it a pandemic. The clinical spectrum ranges from asymptomatic or mildly clinical to situation with high mortality mainly due to severe acute respiratory failure or sepsis and multi-organ failure. The majority of critically ill patients admitted to critical care unit require invasive, non-invasive respiratory support or a combination of both.

The great avalanche of patients who entered to the Madrid hospitals in a very short period of time conditioned unprecedent healthcare pressure on the system and required a structural and functional reorganization  of all centers and  at all levels. This great demand made the available resources at times clearly insufficient and it was necessary to improvise aid and support mechanisms as well as diversify structures and resources even in unusual places and conditions. The crating works team and equipping new ICU beds was one of the greatest needs; at this scenery the Anesthesiology and Reanimation services were fundamental given their capacity for adaptation and aptitud in supporting and managing the critically iil patient.

Non-invasive respiratory support is a fundamental strategy for management of patients with severe acute respiratory failure, both inside and outside ICU; the differents devices available provide their functionally in various clinical situations, although in the beginning of the pandemic their use was not very widespread, first due to fear failure of the technique and second and most importantly due to staff fear of infection by the aerosol dispersion; its efficacy has finally been recognized in situations where the indication is appropriate, the correct time and appropriate facilities.

The PAP SuperNO2VA is a device that is little known until now and that can be useful in specifics cases. In this article, we aim to describe the key characteristics of COVID-19 pneumonia and the role of SRNI systems play in its management, specifically the SuperNO2VA. We describe some cases of its use  in clinical settings during the pandemic.