Abstract Non-invasive ventilation (NIV) has been used as a physiological bridge support to evade intubation. Helium-oxygen (heliox) has been used for many decades in the management of obstructive pulmonary disease. Heliox lower density and high viscosity can significantly decrease airway resistance (Raw) when an anatomical obstruction is present that procreate "asthma-syndrome" airflow limitation (AFL). Viral pathogens may trigger AFL and dyspnea commonly associated with status asthmaticus (SA). An anatomical obstruction (bronchitis, pneumonia) may impede airflow which may impact pulmonary function spirometry (PFS) that may present as persistent unspecific asthma (PUA) is not fully understood may induce respiratory failure (RF). The aim of this report was to describe how the combination of NIV+heliox averted intubation. Case A 30-year-old frontline healthcare professional was hospitalized for impeding RF related SA. She had a history of well controlled asthma. She had 2 previous COVID-19 related intubations. An RT-PCR analysis was positive for human metapneumovirus. PFS was ordered to evaluate pulmonary function status; Forced Vital Capacity (FVC)- 1.61L, Test-2; FVC- 0.76L, Predicted-3.44L, %Predicted-22. Forced Expiratory Volume one second (FEV1) - 0.62 and 0.42L, Predicted-2.75L, %Predicted-15. During bedside testing, her condition acutely and rapidly deteriorated, respiratory rate increased to greater than 55 breaths/min, conversational SpO2 desaturation dropped to 60%. Rapid Response Interventions: Aerosolized Beta-agonists/anticholinergics, non-rebreather oxygen mask, high flow nasal cannula and BiPAP with bronchodilators all delivered sub-par recovery results. She was emergently admitted to MICU where the plan was to intubate. She requested a trial of NIV+heliox to forestall intubation. This was achieved by programming a heliox compatible ventilator for NIV; IPAP; +5 cmH2O, EPAP; +5 cmH2O. A gas cylinder containing pre-mixed 80:20 heliox, 4000 Liters was connected to the ventilator gas module, it was blended to 70:30, aerosolized bronchodilators and steroids administered. After NIV+heliox initiation, respiratory rate decreased to less than 32 breaths/min and SpO2 improved to greater than 92%. She was liberated off NIV+heliox to a nasal cannula, 6 L/min after 12h. Conclusion Was this a case of underlying post COVID-19 syndrome? A viral pulmonary lung infection milieu may make a clear-cut diagnosis obfuscated. Intubation intervention for treatment of viral-induced AFL may be problematic and should be avoided if feasible. The combination of NIV+heliox conceivably circumvented intubation by decreasing Raw, restoration of laminar airflow that improved ventilation and alveolar gas exchange. She was discharged on home oxygen after a 3.5-week hospitalization. This intervention warrants further investigation. This abstract is funded by: None
Morgan et al. (Fri,) studied this question.
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