Author(s)

Ghislain Edjo Nkilly^1*, Raphael Okoue Ondo¹, Fernande Manga², Stéphane Oliveira³, Jean Marcel Mandji-Lawson³, Romain Tchoua¹

¹Department of Emergency Anesthesia Resuscitation, Omar Bongo Ondimba Army Training Hospital, Libreville, Gabon.
²Department of Anesthesia and Resuscitation, Libreville University Hospital Center, Libreville, Gabon.
³Department of Anesthesia and Resuscitation, Akanda Army Training Hospital, Libreville, Gabon.

Importance: The best respiratory support technique to reduce intubation and mortality in patients with respiratory failure due to COVID-19 is controversial. Objective: To determine the respiratory support technique that could reduce the need for tracheal intubation and mortality in patients with respiratory failure due to COVID-19 admitted to intensive care units (ICUs) of Military’s Hospital (HIAOBO) in Gabon. Design, Setting, and Participants-Methodology: Prospective observational study over 10 months (January 2021-October 2021). We included patients admitted to intensive care for SARS Cov2 pneumonia who had benefited from available ventilatory support: high concentration face mask, High Flow Nasal cannula (HFNC), NIV (Non Invasive Ventilation), Continuous Positive Airway Pressure (CPAP). The choice was guided by the clinical condition, and the choice of the prescribing physicians. Recourse to mechanical ventilation was decided when faced with a Glasgow score of less than 13, an SpO₂/FiO₂ ratio ≤ 300, a FR ≥ 35/min, the impossibility of drainage of secretions. Main Outcomes and Measures: The primary outcome was the proportion of patients requiring intubation. The secondary outcomes were mortality in ICU. Results: The sample included 97 patients, the average age was55.6 years, hypertension was the main comorbidity (51.1%). Mean respiratory rate (RR) was 30.8 cycles/min, admission SpO2 was 83%, respiratory alkalosis was present in 63% of patients, mean CT involvement was 51%.Respiratory support was NIV (56.7%), CPAP (21.65%), high concentration face mask (18.55%). Sixteen percent (16%) of patients were intubated, 93% of them following failure of NIV. Mortality was 30%, mechanical ventilation was an independent risk factor for mortality. Conclusions: Non Invasive Ventilation, CPAP, and high-concentration face mask were frequently used in patients with COVID-related acute respiratory failure. The CPAP has reduced the need for intubation. Mechanical ventilation is a risk factor for death.

Respiratory Failure, COVID 19-Intensive Care Units, Military Hospital, Gabon

Nkilly, G. , Ondo, R. , Manga, F. , Oliveira, S. , Mandji-Lawson, J. and Tchoua, R. (2024) Noninvasive Respiratory Strategies in Patients with Acute Hypoxemic Respiratory Failure and COVID-19 in Gabon: A Prospective Observational Study. Open Journal of Emergency Medicine, 12, 18-27. doi: 10.4236/ojem.2024.121003.