The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic
Background In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, baro...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2023-03-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/9/2/00365-2022.full |
| _version_ | 1827931455144067072 |
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| author | Claudia Brusasco Francesco Corradi Federico Dazzi Alessandro Isirdi Chiara Romei Andrea Parisini Silvia Boni Gregorio Santori Vito Brusasco the Galliera CPAP-COVID-19 study group C. Brusasco |
| author_facet | Claudia Brusasco Francesco Corradi Federico Dazzi Alessandro Isirdi Chiara Romei Andrea Parisini Silvia Boni Gregorio Santori Vito Brusasco the Galliera CPAP-COVID-19 study group C. Brusasco |
| author_sort | Claudia Brusasco |
| collection | DOAJ |
| description | Background
In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves.
Methods
281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP.
Results
The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in <4% of patients. Age (OR 1.128; p <0.001) and tomographic severity score (OR 1.139; p=0.006) were the only independent predictors of mortality.
Conclusions
Early treatment with CPAP is a safe option for patients with acute hypoxaemic respiratory failure due to COVID-19. |
| first_indexed | 2024-03-13T06:51:50Z |
| format | Article |
| id | doaj.art-9f4a44328cfc4e438d997f1065d9804a |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-13T06:51:50Z |
| publishDate | 2023-03-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-9f4a44328cfc4e438d997f1065d9804a2023-06-07T13:31:07ZengEuropean Respiratory SocietyERJ Open Research2312-05412023-03-019210.1183/23120541.00365-202200365-2022The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemicClaudia Brusasco0Francesco Corradi1Federico Dazzi2Alessandro Isirdi3Chiara Romei4Andrea Parisini5Silvia Boni6Gregorio Santori7Vito Brusasco8the Galliera CPAP-COVID-19 study groupC. Brusasco Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy Department Radiology, 2nd Radiology Unit, Pisa University-Hospital, Pisa, Italy E.O. Ospedali Galliera, Genoa, Italy E.O. Ospedali Galliera, Genoa, Italy Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy Department of Experimental Medicine, University of Genoa, Genoa, Italy Background In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves. Methods 281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP. Results The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5–12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in <4% of patients. Age (OR 1.128; p <0.001) and tomographic severity score (OR 1.139; p=0.006) were the only independent predictors of mortality. Conclusions Early treatment with CPAP is a safe option for patients with acute hypoxaemic respiratory failure due to COVID-19.http://openres.ersjournals.com/content/9/2/00365-2022.full |
| spellingShingle | Claudia Brusasco Francesco Corradi Federico Dazzi Alessandro Isirdi Chiara Romei Andrea Parisini Silvia Boni Gregorio Santori Vito Brusasco the Galliera CPAP-COVID-19 study group C. Brusasco The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic ERJ Open Research |
| title | The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic |
| title_full | The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic |
| title_fullStr | The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic |
| title_full_unstemmed | The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic |
| title_short | The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic |
| title_sort | use of continuous positive airway pressure during the second and third waves of the covid 19 pandemic |
| url | http://openres.ersjournals.com/content/9/2/00365-2022.full |
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