Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak.
Andrea Coppadoro,Annalisa Benini,Robert Fruscio,Luisa Verga,Paolo Mazzola,Giuseppe Bellelli,Marco Carbone,Giacomo Mulinacci,Alessandro Soria,Beatrice Noè,Eduardo Beck,Riccardo Di Sciacca,Davide Ippolito,Giuseppe Citerio,Maria Grazia Valsecchi,Andrea Biondi,Alberto Pesci,Paolo Bonfanti,Davide Gaudesi,Giacomo Bellani,Giuseppe Foti +20 more
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TLDR
In this paper, a free flow helmet CPAP system was used to provide continuous positive airway pressure (CPAP) noninvasively for patients with care limitations during the COVID-19 pneumonia pandemic.Abstract:
Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).
In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22–32] to 24 [20–29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3–9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards. Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival. Trial Registration: NCT04424992read more
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Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS.
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Luciano Gattinoni,Davide Chiumello,Pietro Caironi,Mattia Busana,Federica Romitti,Luca Brazzi,Luigi Camporota +6 more
TL;DR: It is hypothesize that the different COVID-19 patterns found at presentation in the emergency department depend on the interaction between three factors: the severity of the infection, the host response, physiological reserve and comorbidities; the ventilatory responsiveness of the patient to hypoxemia; and the time elapsed between the onset of the disease and the observation in the hospital.
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