Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study)
Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19 is substantially different from ARDS caused by other diseases and its treatment is dissimilar and challenging. As many studies showed conflicting results regarding the use of Non-invasive ventilation in COVID-19-associated ARDS, no unques...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/11/1/207 |
| _version_ | 1797445583327199232 |
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| author | Francesco Cei Ludia Chiarugi Simona Brancati Silvia Dolenti Maria Silvia Montini Matteo Rosselli Mario Filippelli Chiara Ciacci Irene Sellerio Marco Maria Gucci Giulia Vannini Rinaldo Lavecchia Loredana Staglianò Daniele di Stefano Tiziana Gurrera Mario Romagnoli Valentina Francolini Francesca Dainelli Grazia Panigada Giancarlo Landini Gianluigi Mazzoccoli Roberto Tarquini |
| author_facet | Francesco Cei Ludia Chiarugi Simona Brancati Silvia Dolenti Maria Silvia Montini Matteo Rosselli Mario Filippelli Chiara Ciacci Irene Sellerio Marco Maria Gucci Giulia Vannini Rinaldo Lavecchia Loredana Staglianò Daniele di Stefano Tiziana Gurrera Mario Romagnoli Valentina Francolini Francesca Dainelli Grazia Panigada Giancarlo Landini Gianluigi Mazzoccoli Roberto Tarquini |
| author_sort | Francesco Cei |
| collection | DOAJ |
| description | Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19 is substantially different from ARDS caused by other diseases and its treatment is dissimilar and challenging. As many studies showed conflicting results regarding the use of Non-invasive ventilation in COVID-19-associated ARDS, no unquestionable indications by operational guidelines were reported. The aim of this study was to estimate the use and success rate of Helmet (h) Continuous Positive Airway Pressure (CPAP) in COVID-19-associated ARDS in medical regular wards patients and describe the predictive risk factors for its use and failure. In our monocentric retrospective observational study, we included patients admitted for COVID-19 in medical regular wards. hCPAP was delivered when supplemental conventional or high-flow nasal oxygen failed to achieve respiratory targets. The primary outcomes were hCPAP use and failure rate (including the need to use Bilevel (BL) PAP or oro-tracheal intubation (OTI) and death during ventilation). The secondary outcome was the rate of in-hospital death and OTI. We computed a score derived from the factors independently associated with hCPAP failure. Out of 701 patients admitted with COVID-19 symptoms, 295 were diagnosed with ARDS caused by COVID-19 and treated with hCPAP. Factors associated with the need for hCPAP use were the PaO<sub>2</sub>/FiO<sub>2</sub> ratio < 270, IL-6 serum levels over 46 pg/mL, AST > 33 U/L, and LDH > 570 U/L; age > 78 years and neuropsychiatric conditions were associated with lower use of hCPAP. Failure of hCPAP occurred in 125 patients and was associated with male sex, polypharmacotherapy (at least three medications), platelet count < 180 × 10<sup>9</sup>/L, and PaO<sub>2</sub>/FiO<sub>2</sub> ratio < 240. The computed hCPAP-f Score, ranging from 0 to 11.5 points, had an AUC of 0.74 in predicting hCPAP failure (significantly superior to Call Score), and 0.73 for the secondary outcome (non-inferior to IL-6 serum levels). In conclusion, hCPAP was widely used in patients with COVID-19 symptoms admitted to medical regular wards and developing ARDS, with a low OTI rate. A score computed combining male sex, multi-pharmacotherapy, low platelet count, and low PaO<sub>2</sub>/FiO<sub>2</sub> was able to predict hCPAP failure in hospitalized patients with ARDS caused by COVID-19. |
| first_indexed | 2024-03-09T13:27:57Z |
| format | Article |
| id | doaj.art-1fb8c2fef55f425a87fca91034297b0b |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-09T13:27:57Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-1fb8c2fef55f425a87fca91034297b0b2023-11-30T21:21:02ZengMDPI AGBiomedicines2227-90592023-01-0111120710.3390/biomedicines11010207Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study)Francesco Cei0Ludia Chiarugi1Simona Brancati2Silvia Dolenti3Maria Silvia Montini4Matteo Rosselli5Mario Filippelli6Chiara Ciacci7Irene Sellerio8Marco Maria Gucci9Giulia Vannini10Rinaldo Lavecchia11Loredana Staglianò12Daniele di Stefano13Tiziana Gurrera14Mario Romagnoli15Valentina Francolini16Francesca Dainelli17Grazia Panigada18Giancarlo Landini19Gianluigi Mazzoccoli20Roberto Tarquini21Division of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine II, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine II, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine II, San Giuseppe Hospital, 50053 Empoli, ItalyDivision of Internal Medicine, SS Cosma and Damiano Hospital, 51017 Pescia, ItalyDivision of Internal Medicine, Santa Maria Nuova Hospital, 50100 Firenze, ItalyDivision of Internal Medicine, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, ItalyDivision of Internal Medicine I, San Giuseppe Hospital, 50053 Empoli, ItalyAcute Respiratory Distress Syndrome (ARDS) caused by COVID-19 is substantially different from ARDS caused by other diseases and its treatment is dissimilar and challenging. As many studies showed conflicting results regarding the use of Non-invasive ventilation in COVID-19-associated ARDS, no unquestionable indications by operational guidelines were reported. The aim of this study was to estimate the use and success rate of Helmet (h) Continuous Positive Airway Pressure (CPAP) in COVID-19-associated ARDS in medical regular wards patients and describe the predictive risk factors for its use and failure. In our monocentric retrospective observational study, we included patients admitted for COVID-19 in medical regular wards. hCPAP was delivered when supplemental conventional or high-flow nasal oxygen failed to achieve respiratory targets. The primary outcomes were hCPAP use and failure rate (including the need to use Bilevel (BL) PAP or oro-tracheal intubation (OTI) and death during ventilation). The secondary outcome was the rate of in-hospital death and OTI. We computed a score derived from the factors independently associated with hCPAP failure. Out of 701 patients admitted with COVID-19 symptoms, 295 were diagnosed with ARDS caused by COVID-19 and treated with hCPAP. Factors associated with the need for hCPAP use were the PaO<sub>2</sub>/FiO<sub>2</sub> ratio < 270, IL-6 serum levels over 46 pg/mL, AST > 33 U/L, and LDH > 570 U/L; age > 78 years and neuropsychiatric conditions were associated with lower use of hCPAP. Failure of hCPAP occurred in 125 patients and was associated with male sex, polypharmacotherapy (at least three medications), platelet count < 180 × 10<sup>9</sup>/L, and PaO<sub>2</sub>/FiO<sub>2</sub> ratio < 240. The computed hCPAP-f Score, ranging from 0 to 11.5 points, had an AUC of 0.74 in predicting hCPAP failure (significantly superior to Call Score), and 0.73 for the secondary outcome (non-inferior to IL-6 serum levels). In conclusion, hCPAP was widely used in patients with COVID-19 symptoms admitted to medical regular wards and developing ARDS, with a low OTI rate. A score computed combining male sex, multi-pharmacotherapy, low platelet count, and low PaO<sub>2</sub>/FiO<sub>2</sub> was able to predict hCPAP failure in hospitalized patients with ARDS caused by COVID-19.https://www.mdpi.com/2227-9059/11/1/207hCPAPnon-invasive ventilationCOVID-19SARS-CoV-2ARDSprognosis |
| spellingShingle | Francesco Cei Ludia Chiarugi Simona Brancati Silvia Dolenti Maria Silvia Montini Matteo Rosselli Mario Filippelli Chiara Ciacci Irene Sellerio Marco Maria Gucci Giulia Vannini Rinaldo Lavecchia Loredana Staglianò Daniele di Stefano Tiziana Gurrera Mario Romagnoli Valentina Francolini Francesca Dainelli Grazia Panigada Giancarlo Landini Gianluigi Mazzoccoli Roberto Tarquini Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study) Biomedicines hCPAP non-invasive ventilation COVID-19 SARS-CoV-2 ARDS prognosis |
| title | Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study) |
| title_full | Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study) |
| title_fullStr | Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study) |
| title_full_unstemmed | Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study) |
| title_short | Clinical and Personal Predictors of Helmet-CPAP Use and Failure in Patients Firstly Admitted to Regular Medical Wards with COVID-19-Related Acute Respiratory Distress Syndrome (hCPAP-f Study) |
| title_sort | clinical and personal predictors of helmet cpap use and failure in patients firstly admitted to regular medical wards with covid 19 related acute respiratory distress syndrome hcpap f study |
| topic | hCPAP non-invasive ventilation COVID-19 SARS-CoV-2 ARDS prognosis |
| url | https://www.mdpi.com/2227-9059/11/1/207 |
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