Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients

Yesim Yaman Aktaş; Neziha Karabulut; Sedanur Çatal; Hatice Oğuzhan

doi:10.37989/gumussagbil.1228533

Research Article

Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients

Year 2023, Volume: 12 Issue: 2, 534 - 540, 18.06.2023

Yesim Yaman Aktaş Neziha Karabulut Sedanur Çatal Hatice Oğuzhan

https://doi.org/10.37989/gumussagbil.1228533

Abstract

The aim of this study was to examine the results of NIMV applied with a full face mask in COVID-19 patients. A descriptive and cross-sectional study. The study was conducted in the 1st level COVID-19 Intensive Care Unit of a university training and research hospital between August 15 and November 15, 2021. The study included 31 critical care patients who agreed to participate in the study and met the sampling criteria. The data was collected by the third researcher using the questionnaire based on the literature. The mean age of patients was 68.90±9.97 (41-82) years. In the measurements before NIMV, after the first application and after 24-h, a statistically significant difference was found between measurements in terms of SpO2 scores (p<0.001). In venous blood gas measurements before and 24-h after NIMV, a statistically significant difference was found between the measurements in terms of PCO2 scores (p<0.05). The study findings showed that NIMV was effective in terms of SpO2 and venous PCO2 scores in COVID-19 patients. It can be used as an effective option in the management of acute hypoxemic respiratory failure in COVID-19 patients.

Keywords

COVID-19, noninvasive mechanical ventilation, critical care, patient

References

1. Wu, Z., & McGoogan, J. M. (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13), 1239-1242. https://doi.org/10.1001/jama.2020.2648
2. Rollas, K., & Şenoğlu, N. (2020). Management of Covid-19 patients ın ıntensive care unit. Tepecik Eğitim ve Araştırma Hastanesi Dergisi, 30, 142-55. https://doi.org/10.5222/terh.2020.77044
3. Turkish Ministry of Health General Directorate of Public Health COVID-19 (SARS-CoV-2 Infection) Guide (Scientific committee study), https://covid19bilgi.saglik.gov.tr [date of Access: 14 September 2022].
4. Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., ... & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
5. Turkish Internal and Surgical Intensive Care Association COVID-19 disease follow-up recommendations, https://www.dcyogunbakim.org.tr/tdcy-covid-19-hastaligi-follow-onerileri/ [date of Access: 14 September 2022].
6. Carter, C., Aedy, H., & Notter, J. (2020). COVID-19 disease: Non-Invasive Ventilation and high frequency nasal oxygenation. Clinics in Integrated Care, 1, 100006. https://doi.org/10.1016/j.intcar.2020.100006
7. Ashraf-Kashani, N., & Kumar, R. (2017). High-flow nasal oxygen therapy. BJA Education, 17(2), 63-67. https://doi.org/10.1093/bjaed/mkw041
8. Avdeev, S. N., Yaroshetskiy, A. I., Tsareva, N. A., Merzhoeva, Z. M., Trushenko, N. V., Nekludova, G. V., & Chikina, S. Y. (2021). Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19. The American Journal of Emergency Medicine, 39, 154-157. https://doi.org/10.1016/j.ajem.2020.09.075
9. Ferrer, M., Esquinas, A., Leon, M., Gonzalez, G., Alarcon, A., & Torres, A. (2003). Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. American Journal of Respiratory and Critical Care Medicine, 168(12), 1438-1444. https://doi.org/10.1164/rccm.200301-072OC
10. Wang, Z., Wang, Y., Yang, Z., Wu, H., Liang, J., Liang, H., ... & Li, S. (2021). The use of non-invasive ventilation in COVID-19: a systematic review. International Journal of Infectious Diseases, 106, 254-261. https://doi.org/10.1016/j.ijid.2021.03.078
11. Ferioli, M., Cisternino, C., Leo, V., Pisani, L., Palange, P., & Nava, S. (2020). Protecting healthcare workers from SARS-CoV-2 infection: practical indications. European Respiratory Review, 29(155), 200068. https://doi.org/10.1183/16000617.0068-2020
12. Radovanovic, D., Rizzi, M., Pini, S., Saad, M., Chiumello, D. A., & Santus, P. (2020). Helmet CPAP to treat acute hypoxemic respiratory failure in patients with COVID-19: a management strategy proposal. Journal of Clinical Medicine, 9(4), 1191. https://doi.org/10.3390/jcm9041191
13. Vitacca, M., Nava, S., Santus, P., & Harari, S. (2020). Early consensus management for non-ICU acute respiratory failure SARS-CoV-2 emergency in Italy: from ward to trenches. European Respiratory Journal, 55(5), 2000632. https://doi.org/10.1183/13993003.00632-2020
14. Garcés, H. H., Muncharaz, A. B., & Crespo, R. Z. (2020). Noninvasive mechanical ventilation and COVID-19. Minimizing dispersion. Medicina Intensiva, 44(8), 520. https://doi.org/10.1016/j.medin.2020.03.015
15. Brambilla, A. M., Aliberti, S., Prina, E., Nicoli, F., Forno, M. D., Nava, S., ... & Cosentini, R. (2014). Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Medicine, 40(7), 942-949. https://doi.org/10.1007/s00134-014-3325-5
16. Cosentini, R., Brambilla, A. M., Aliberti, S., Bignamini, A., Nava, S., Maffei, A., ... & Pelosi, P. (2010). Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial. Chest, 138(1), 114-120. https://doi.org/10.1378/chest.09-2290
17. Xu, X. P., Zhang, X. C., Hu, S. L., Xu, J. Y., Xie, J. F., Liu, S. Q., ... & Qiu, H. B. (2017). Noninvasive ventilation in acute hypoxemic nonhypercapnic respiratory failure: a systematic review and meta-analysis. Critical Care Medicine, 45(7), e727. https://doi.org/10.1097/CCM.0000000000002361
18. Akbudak, İ. H. (2021). Retrospective evaluation of critical patients followed in intensive care with the diagnosis of COVID-19 infection: single center experience. Pamukkale Medical Journal, 14(2), 438-442. https://dx.doi.org/10.31362/patd.848721
19. Aliberti, S., Radovanovic, D., Billi, F., Sotgiu, G., Costanzo, M., Pilocane, T., ... & Blasi, F. (2020). Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study. European Respiratory Journal, 56(4), 2001935. https://doi.org/10.1183/13993003.01935-2020
20. Bellani, G., Grasselli, G., Cecconi, M., Antolini, L., Borelli, M., De Giacomi, F., ... & Foti, G. (2021). Noninvasive ventilatory support of patients with COVID-19 outside the intensive care units (WARd-COVID). Annals of the American Thoracic Society, 18(6), 1020-1026. https://doi.org/10.1513/AnnalsATS.202008-1080OC
21. Chen, R., Liang, W., Jiang, M., Guan, W., Zhan, C., Wang, T., ... & for COVID, M. T. E. G. (2020). Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest, 158(1), 97-105. https://doi.org/10.1016/j.chest.2020.04.010
22. Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E., ... & Rhodes, A. (2020). Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine, 46(5), 854-887. https://doi.org/10.1007/s00134-020-06022-5
23. Kluge, S., Janssens, U., Welte, T., Weber-Carstens, S., Marx, G., & Karagiannidis, C. (2020). German recommendations for critically ill patients with COVID‑19. Medizinische Klinik-Intensivmedizin und Notfallmedizin, 115(3), 111-114. https://doi.org/10.1007/s00063-020-00689-w
24. Bakoğlu, E., Kebapçıoğlu, A. S., Ak, A., Girişgin, A. S., & Zararsız, İ. (2013). Investigation of the utility of peripheral venous blood gas ınstead of arterial blood gas in the emergency department. European Journal of Basic Medical Science, 3(2), 29-33.
25. Çırak, A. K., Cireli, E., Mertoğlu, A., Deniz, S., Tekgül, S., Varol, Y., ... & Yalnız, E. The feasibility of venous blood gas instead of arterial blood gas in patients hospitalized for chronic obstructive pulmonary diseases acute exacerbation. Journal of İzmir Chest Hospital, 36(1), 28-32. https://doi.org/10.14744/IGH.2022.40469
26. Parlak, E. Ş., Pempeci, S., Karalezli, A., & Hasanoglu, H. C. (2019). Can venous blood gases be used instead of arterial blood gases in department of chest diseases? Ankara Medical Journal, 19(1), 157-163. https://doi.org/10.17098/amj.542129
27. Menzella, F., Barbieri, C., Fontana, M., Scelfo, C., Castagnetti, C., Ghidoni, G., ... & Facciolongo, N. (2021). Effectiveness of noninvasive ventilation in COVID‐19 related‐acute respiratory distress syndrome. The Clinical Respiratory Journal, 15(7), 779-787. https://doi.org/10.1111/crj.13361
28. NHS (NIV). Guidance for the role and use of non-invasive respiratory support in adult patients with COVID-19 (confirmed or suspected), https:// wwwenglandnhsuk/coronavirus/wp-content/uploads/sites/52/2020/03/specialty-guide-NIV-respiratory-support-and-coronavirus-v3pdf [date of access 01 November 2022].
29. Mukhtar, A., Lotfy, A., Hasanin, A., El-Hefnawy, I., & El Adawy, A. (2020). Outcome of non-invasive ventilation in COVID-19 critically ill patients: a retrospective observational study. Anaesthesia, Critical Care & Pain Medicine, 39(5), 579. https://doi.org/10.1016/j.accpm.2020.07.012

COVID-19 Hastalarında Noninvazif Mekanik Ventilasyonun Etkileri

Year 2023, Volume: 12 Issue: 2, 534 - 540, 18.06.2023

Yesim Yaman Aktaş Neziha Karabulut Sedanur Çatal Hatice Oğuzhan

https://doi.org/10.37989/gumussagbil.1228533

Abstract

Bu çalışmanın amacı, COVID-19 hastalarında tam yüz maskesi ile uygulanan NIMV sonuçlarının incelenmesidir. Tanımlayıcı ve kesitsel bir çalışmadır. Bu çalışma bir üniversite eğitim ve araştırma hastanesinin 1. basamak COVID-19 Yoğun Bakım Ünitesinde 15 Ağustos-15 Kasım 2021 tarihleri arasında yapıldı. Araştırmanın örneklemini araştırmaya katılmayı kabul eden ve örneklem kriterlerine uyan 31 yoğun bakım hastası oluşturdu. Veriler literatür doğrultusunda hazırlanan anket kullanılarak üçüncü araştırmacı tarafından toplandı. Bulgular: Hastaların yaş ortalaması 68.90±9.97 (41-82) idi. NIMV öncesi, ilk uygulama sonrası ve 24 saat sonra yapılan ölçümlerde SpO2 skorları açısından ölçümler arasında istatistiksel olarak anlamlı fark bulundu (p<0.001). NIMV öncesi ve 24 saat sonra venöz kan gazı ölçümlerinde PCO2 skorları açısından ölçümler arasında istatistiksel olarak anlamlı fark bulundu (p<0.05). Çalışma bulguları, NIMV'nin COVID-19 hastalarında SpO2 ve venöz PCO2 skorları açısından etkili olduğunu göstermiştir. COVID-19 hastalarında akut hipoksemik solunum yetmezliğinin tedavisinde etkili bir seçenek olarak kullanılabilir.

Keywords

COVID-19, noninvazif mekanik ventilasyon, yoğun bakım, hasta

References

1. Wu, Z., & McGoogan, J. M. (2020). Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA, 323(13), 1239-1242. https://doi.org/10.1001/jama.2020.2648
2. Rollas, K., & Şenoğlu, N. (2020). Management of Covid-19 patients ın ıntensive care unit. Tepecik Eğitim ve Araştırma Hastanesi Dergisi, 30, 142-55. https://doi.org/10.5222/terh.2020.77044
3. Turkish Ministry of Health General Directorate of Public Health COVID-19 (SARS-CoV-2 Infection) Guide (Scientific committee study), https://covid19bilgi.saglik.gov.tr [date of Access: 14 September 2022].
4. Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., ... & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
5. Turkish Internal and Surgical Intensive Care Association COVID-19 disease follow-up recommendations, https://www.dcyogunbakim.org.tr/tdcy-covid-19-hastaligi-follow-onerileri/ [date of Access: 14 September 2022].
6. Carter, C., Aedy, H., & Notter, J. (2020). COVID-19 disease: Non-Invasive Ventilation and high frequency nasal oxygenation. Clinics in Integrated Care, 1, 100006. https://doi.org/10.1016/j.intcar.2020.100006
7. Ashraf-Kashani, N., & Kumar, R. (2017). High-flow nasal oxygen therapy. BJA Education, 17(2), 63-67. https://doi.org/10.1093/bjaed/mkw041
8. Avdeev, S. N., Yaroshetskiy, A. I., Tsareva, N. A., Merzhoeva, Z. M., Trushenko, N. V., Nekludova, G. V., & Chikina, S. Y. (2021). Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19. The American Journal of Emergency Medicine, 39, 154-157. https://doi.org/10.1016/j.ajem.2020.09.075
9. Ferrer, M., Esquinas, A., Leon, M., Gonzalez, G., Alarcon, A., & Torres, A. (2003). Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. American Journal of Respiratory and Critical Care Medicine, 168(12), 1438-1444. https://doi.org/10.1164/rccm.200301-072OC
10. Wang, Z., Wang, Y., Yang, Z., Wu, H., Liang, J., Liang, H., ... & Li, S. (2021). The use of non-invasive ventilation in COVID-19: a systematic review. International Journal of Infectious Diseases, 106, 254-261. https://doi.org/10.1016/j.ijid.2021.03.078
11. Ferioli, M., Cisternino, C., Leo, V., Pisani, L., Palange, P., & Nava, S. (2020). Protecting healthcare workers from SARS-CoV-2 infection: practical indications. European Respiratory Review, 29(155), 200068. https://doi.org/10.1183/16000617.0068-2020
12. Radovanovic, D., Rizzi, M., Pini, S., Saad, M., Chiumello, D. A., & Santus, P. (2020). Helmet CPAP to treat acute hypoxemic respiratory failure in patients with COVID-19: a management strategy proposal. Journal of Clinical Medicine, 9(4), 1191. https://doi.org/10.3390/jcm9041191
13. Vitacca, M., Nava, S., Santus, P., & Harari, S. (2020). Early consensus management for non-ICU acute respiratory failure SARS-CoV-2 emergency in Italy: from ward to trenches. European Respiratory Journal, 55(5), 2000632. https://doi.org/10.1183/13993003.00632-2020
14. Garcés, H. H., Muncharaz, A. B., & Crespo, R. Z. (2020). Noninvasive mechanical ventilation and COVID-19. Minimizing dispersion. Medicina Intensiva, 44(8), 520. https://doi.org/10.1016/j.medin.2020.03.015
15. Brambilla, A. M., Aliberti, S., Prina, E., Nicoli, F., Forno, M. D., Nava, S., ... & Cosentini, R. (2014). Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia. Intensive Care Medicine, 40(7), 942-949. https://doi.org/10.1007/s00134-014-3325-5
16. Cosentini, R., Brambilla, A. M., Aliberti, S., Bignamini, A., Nava, S., Maffei, A., ... & Pelosi, P. (2010). Helmet continuous positive airway pressure vs oxygen therapy to improve oxygenation in community-acquired pneumonia: a randomized, controlled trial. Chest, 138(1), 114-120. https://doi.org/10.1378/chest.09-2290
17. Xu, X. P., Zhang, X. C., Hu, S. L., Xu, J. Y., Xie, J. F., Liu, S. Q., ... & Qiu, H. B. (2017). Noninvasive ventilation in acute hypoxemic nonhypercapnic respiratory failure: a systematic review and meta-analysis. Critical Care Medicine, 45(7), e727. https://doi.org/10.1097/CCM.0000000000002361
18. Akbudak, İ. H. (2021). Retrospective evaluation of critical patients followed in intensive care with the diagnosis of COVID-19 infection: single center experience. Pamukkale Medical Journal, 14(2), 438-442. https://dx.doi.org/10.31362/patd.848721
19. Aliberti, S., Radovanovic, D., Billi, F., Sotgiu, G., Costanzo, M., Pilocane, T., ... & Blasi, F. (2020). Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study. European Respiratory Journal, 56(4), 2001935. https://doi.org/10.1183/13993003.01935-2020
20. Bellani, G., Grasselli, G., Cecconi, M., Antolini, L., Borelli, M., De Giacomi, F., ... & Foti, G. (2021). Noninvasive ventilatory support of patients with COVID-19 outside the intensive care units (WARd-COVID). Annals of the American Thoracic Society, 18(6), 1020-1026. https://doi.org/10.1513/AnnalsATS.202008-1080OC
21. Chen, R., Liang, W., Jiang, M., Guan, W., Zhan, C., Wang, T., ... & for COVID, M. T. E. G. (2020). Risk factors of fatal outcome in hospitalized subjects with coronavirus disease 2019 from a nationwide analysis in China. Chest, 158(1), 97-105. https://doi.org/10.1016/j.chest.2020.04.010
22. Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E., ... & Rhodes, A. (2020). Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine, 46(5), 854-887. https://doi.org/10.1007/s00134-020-06022-5
23. Kluge, S., Janssens, U., Welte, T., Weber-Carstens, S., Marx, G., & Karagiannidis, C. (2020). German recommendations for critically ill patients with COVID‑19. Medizinische Klinik-Intensivmedizin und Notfallmedizin, 115(3), 111-114. https://doi.org/10.1007/s00063-020-00689-w
24. Bakoğlu, E., Kebapçıoğlu, A. S., Ak, A., Girişgin, A. S., & Zararsız, İ. (2013). Investigation of the utility of peripheral venous blood gas ınstead of arterial blood gas in the emergency department. European Journal of Basic Medical Science, 3(2), 29-33.
25. Çırak, A. K., Cireli, E., Mertoğlu, A., Deniz, S., Tekgül, S., Varol, Y., ... & Yalnız, E. The feasibility of venous blood gas instead of arterial blood gas in patients hospitalized for chronic obstructive pulmonary diseases acute exacerbation. Journal of İzmir Chest Hospital, 36(1), 28-32. https://doi.org/10.14744/IGH.2022.40469
26. Parlak, E. Ş., Pempeci, S., Karalezli, A., & Hasanoglu, H. C. (2019). Can venous blood gases be used instead of arterial blood gases in department of chest diseases? Ankara Medical Journal, 19(1), 157-163. https://doi.org/10.17098/amj.542129
27. Menzella, F., Barbieri, C., Fontana, M., Scelfo, C., Castagnetti, C., Ghidoni, G., ... & Facciolongo, N. (2021). Effectiveness of noninvasive ventilation in COVID‐19 related‐acute respiratory distress syndrome. The Clinical Respiratory Journal, 15(7), 779-787. https://doi.org/10.1111/crj.13361
28. NHS (NIV). Guidance for the role and use of non-invasive respiratory support in adult patients with COVID-19 (confirmed or suspected), https:// wwwenglandnhsuk/coronavirus/wp-content/uploads/sites/52/2020/03/specialty-guide-NIV-respiratory-support-and-coronavirus-v3pdf [date of access 01 November 2022].
29. Mukhtar, A., Lotfy, A., Hasanin, A., El-Hefnawy, I., & El Adawy, A. (2020). Outcome of non-invasive ventilation in COVID-19 critically ill patients: a retrospective observational study. Anaesthesia, Critical Care & Pain Medicine, 39(5), 579. https://doi.org/10.1016/j.accpm.2020.07.012

There are 29 citations in total.

Details

Primary Language	English
Subjects	Health Care Administration
Journal Section	Original Article
Authors	Yesim Yaman Aktaş 0000-0001-7403-4949 Neziha Karabulut 0000-0002-4621-0957 Sedanur Çatal 0000-0002-8952-8834 Hatice Oğuzhan 0000-0003-2343-8673
Publication Date	June 18, 2023
Published in Issue	Year 2023 Volume: 12 Issue: 2

Cite

APA	Yaman Aktaş, Y., Karabulut, N., Çatal, S., Oğuzhan, H. (2023). Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 12(2), 534-540. https://doi.org/10.37989/gumussagbil.1228533
AMA	Yaman Aktaş Y, Karabulut N, Çatal S, Oğuzhan H. Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. June 2023;12(2):534-540. doi:10.37989/gumussagbil.1228533
Chicago	Yaman Aktaş, Yesim, Neziha Karabulut, Sedanur Çatal, and Hatice Oğuzhan. “Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12, no. 2 (June 2023): 534-40. https://doi.org/10.37989/gumussagbil.1228533.
EndNote	Yaman Aktaş Y, Karabulut N, Çatal S, Oğuzhan H (June 1, 2023) Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12 2 534–540.
IEEE	Y. Yaman Aktaş, N. Karabulut, S. Çatal, and H. Oğuzhan, “Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 2, pp. 534–540, 2023, doi: 10.37989/gumussagbil.1228533.
ISNAD	Yaman Aktaş, Yesim et al. “Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 12/2 (June 2023), 534-540. https://doi.org/10.37989/gumussagbil.1228533.
JAMA	Yaman Aktaş Y, Karabulut N, Çatal S, Oğuzhan H. Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12:534–540.
MLA	Yaman Aktaş, Yesim et al. “Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, vol. 12, no. 2, 2023, pp. 534-40, doi:10.37989/gumussagbil.1228533.
Vancouver	Yaman Aktaş Y, Karabulut N, Çatal S, Oğuzhan H. Effects of Noninvasive Mechanical Ventilation in COVID-19 Patients. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2023;12(2):534-40.

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