# Use of a gas-operated ventilator as a noninvasive bridging respiratory therapy in critically Ill COVID-19 patients in a middle-income country

## TL;DR

This study shows that gas-operated ventilators can be used as a noninvasive bridging therapy for critically ill COVID-19 patients in middle-income countries when standard equipment is scarce.

## Contribution

The study evaluates gas-operated ventilators as an alternative respiratory therapy in resource-limited settings during the COVID-19 pandemic.

## Key findings

- Gas-operated ventilators were used as noninvasive bridging therapy in 58% of patients.
- Clinical outcomes with gas-operated ventilators were comparable to noninvasive ventilation.
- Gas-operated ventilators reduced the need for intubation in some patients compared to conventional oxygen therapy.

## Abstract

During the COVID-19 pandemic, there was a notable undersupply of respiratory support devices, especially in low- and middle-income countries. As a result, many hospitals turned to alternative respiratory therapies, including the use of gas-operated ventilators (GOV). The aim of this study was to describe the use of GOV as a noninvasive bridging respiratory therapy in critically ill COVID-19 patients and to compare clinical outcomes achieved with this device to conventional respiratory therapies. Retrospective cohort analysis of critically ill COVID-19 patients during the first local wave of the pandemic. The final analysis included 204 patients grouped according to the type of respiratory therapy received in the first 24 h, as follows: conventional oxygen therapy (COT), n = 28 (14%); GOV, n = 72 (35%); noninvasive ventilation (NIV), n = 49 (24%); invasive mechanical ventilation (IMV), n = 55 (27%). In 72, GOV served as noninvasive bridging respiratory therapy in 42 (58%) of these patients. In the other 30 patients (42%), 20 (28%) presented clinical improvement and were discharged; 10 (14%) died. In the COT and GOV groups, 68% and 39%, respectively, progressed to intubation (P ≤ 0.001). Clinical outcomes in the GOV and NIV groups were similar (no statistically significant differences). GOV was successfully used as a noninvasive bridging respiratory therapy in more than half of patients. Clinical outcomes in the GOV group were comparable to those of the NIV group. These findings support the use of GOV as an emergency, noninvasive bridging respiratory therapy in medical crises when alternative approaches to the standard of care may be justifiable.

The online version contains supplementary material available at 10.1007/s11739-024-03681-w.