• Arthur Kwizera, Daphne Kabatooro, Patience Atumanya, Janat Tumukunde, Joyce Kalungi, MwanjeArthur KavumaAKDepartment of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda., Daniel Obua, Peter Agaba, Cornelius Sendagire, Jane Nakibuuka, Darius Owachi, Martin W Dünser, Anne Alenyo-Ngabirano, Charles Olaro, Henry Kyobe-Bosa, Bruce J Kirenga, Lydia Nakiyingi, Noah Kiwanuka, David Patrick Kateete, Moses Joloba, Nelson Sewankambo, and Charlotte Summers.
• Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda. Electronic address: kwizera.arthur@gmail.com.
• Chest. 2023 Aug 1; 164 (2): 369380369-380.

BackgroundLimited data from low-income countries report on respiratory support techniques in COVID-19-associated ARDS.Research QuestionWhich respiratory support techniques are used in patients with COVID-19-associated ARDS in Uganda?Study Design And MethodsA multicenter, prospective, observational study was conducted at 13 Ugandan hospitals during the pandemic and included adults with COVID-19-associated ARDS. Patient characteristics, clinical and laboratory data, initial and most advanced respiratory support techniques, and 28-day mortality were recorded. Standard tests, log-rank tests, and logistic regression analyses were used for statistical analyses.ResultsFour hundred ninety-nine patients with COVID-19-associated ARDS (mild, n = 137; moderate, n = 247; and severe, n = 115) were included (ICU admission, 38.9%). Standard oxygen therapy (SOX), high-flow nasal oxygen (HFNO), CPAP, noninvasive ventilation (NIV), and invasive mechanical ventilation (IMV) was used as the first-line (most advanced) respiratory support technique in 37.3% (35.3%), 10% (9.4%), 11.6% (4.8%), 23.4% (14.4%), and 17.6% (36.6%) of patients, respectively. The first-line respiratory support technique was escalated in 19.8% of patients. Twenty-eight-day mortality was 51.9% (mild ARDS, 13.1%; moderate ARDS, 62.3%; severe ARDS, 75.7%; P < .001) and was associated with respiratory support techniques as follows: SOX, 19.9%; HFNO, 31.9%; CPAP, 58.3%; NIV 61.1%; and IMV, 83.9% (P < .001). Proning was used in 79 patients (15.8%; 59 of 79 awake) and was associated with lower mortality (40.5% vs 54%; P = .03). The oxygen saturation to Fio2 ratio (OR, 0.99; 95% CI, 0.98-0.99; P < .001) and respiratory rate (OR, 1.07; 95% CI, 1.03-1.12; P = .002) at admission and NIV (OR, 6.31; 95% CI, 2.29-17.37; P < .001) or IMV (OR, 8.08; 95% CI, 3.52-18.57; P < .001) use were independent risk factors for death.InterpretationSOX, HFNO, CPAP, NIV, and IMV were used as respiratory support techniques in patients with COVID-19-associated ARDS in Uganda. Although these data are observational, they suggest that the use of SOX and HFNO therapy as well as awake proning are associated with a lower mortality resulting from COVID-19-associated ARDS in a resource-limited setting.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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