Development of a work of breathing scale and monitoring need of intubation in COVID-19 pneumonia

Abstract

Noninvasive ventilation and high-flow nasal cannula (HFNC) are reasonable initial interventions reserving endotracheal intubation for worsening disease severity evidenced by increased work of breathing (WOB), risking respiratory muscle fatigue leading to hypoventilation, hypoxemia, and cardiac arrest and large transpulmonary pressure swings risking patient self-inflicted lung injury (SILI) [3, 4]. Super-raters trained raters using a 4-min WOB scale video and tested their ability to correctly rate the WOB level in 80 non-intubated patients from the Emergency Department, medical wards, and the ICU with WOB ranging from 1 to 5. SEE PDF] We examined the performance of our WOB scale in 10 patients admitted to the ICU with radiographic evidence of extensive COVID-19 pneumonia, significant hypoxemia, and multiple risk factors associated with poor outcome.