Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study
Background Respiratory failure is a severe complication in coronavirus disease 2019 (COVID-19) pneumonia that, in addition to oxygen therapy, may require continuous positive airway pressure (CPAP) support. It has been postulated that COVID-19 lung injury may share some features with those observed i...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
European Respiratory Society
2023-04-01
|
| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/9/2/00455-2022.full |
| _version_ | 1797809384777056256 |
|---|---|
| author | Alessandra Iacovelli Maria Luisa Nicolardi Valentina Baccolini Federica Olmati Ilenia Attilia Pia Baiocchi Letizia D'Antoni Ilaria Menichini Ambra Migliarini Daniela Pellegrino Angelo Petroianni Daniel Piamonti Angela Tramontano Paolo Villari Paolo Palange |
| author_facet | Alessandra Iacovelli Maria Luisa Nicolardi Valentina Baccolini Federica Olmati Ilenia Attilia Pia Baiocchi Letizia D'Antoni Ilaria Menichini Ambra Migliarini Daniela Pellegrino Angelo Petroianni Daniel Piamonti Angela Tramontano Paolo Villari Paolo Palange |
| author_sort | Alessandra Iacovelli |
| collection | DOAJ |
| description | Background
Respiratory failure is a severe complication in coronavirus disease 2019 (COVID-19) pneumonia that, in addition to oxygen therapy, may require continuous positive airway pressure (CPAP) support. It has been postulated that COVID-19 lung injury may share some features with those observed in hyperoxic acute lung injury. Thus, a correct target arterial oxygen tension (PaO2) during oxygen supplementation may be crucial to protect the lung from further tissue damage. The aims of this study were: 1) to evaluate the effects of conservative oxygen supplementation during helmet CPAP therapy on mortality and intensive care unit (ICU) admission in patients with COVID-19 and respiratory failure, and 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections.
Methods
This was a single-centre, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or nonconservative oxygen supplementation during helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target PaO2 <100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation.
Results
71 patients were included in the conservative cohort and 75 in the nonconservative cohort. Mortality rate was lower in the conservative cohort (22.5% versus 62.7%; p<0.001). Rates of ICU admission and new-onset organ failure were lower in the conservative cohort (14.1% versus 37.3%; p=0.001 and 9.9% versus 45.3%; p<0.001, respectively).
Conclusions
In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during helmet CPAP was associated with improved survival, lower ICU admission rate and less new-onset organ failure. |
| first_indexed | 2024-03-13T06:51:51Z |
| format | Article |
| id | doaj.art-a3050be5cd5e46c78d5d687c11cf43de |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-03-13T06:51:51Z |
| publishDate | 2023-04-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-a3050be5cd5e46c78d5d687c11cf43de2023-06-07T13:31:08ZengEuropean Respiratory SocietyERJ Open Research2312-05412023-04-019210.1183/23120541.00455-202200455-2022Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot studyAlessandra Iacovelli0Maria Luisa Nicolardi1Valentina Baccolini2Federica Olmati3Ilenia Attilia4Pia Baiocchi5Letizia D'Antoni6Ilaria Menichini7Ambra Migliarini8Daniela Pellegrino9Angelo Petroianni10Daniel Piamonti11Angela Tramontano12Paolo Villari13Paolo Palange14 Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy Background Respiratory failure is a severe complication in coronavirus disease 2019 (COVID-19) pneumonia that, in addition to oxygen therapy, may require continuous positive airway pressure (CPAP) support. It has been postulated that COVID-19 lung injury may share some features with those observed in hyperoxic acute lung injury. Thus, a correct target arterial oxygen tension (PaO2) during oxygen supplementation may be crucial to protect the lung from further tissue damage. The aims of this study were: 1) to evaluate the effects of conservative oxygen supplementation during helmet CPAP therapy on mortality and intensive care unit (ICU) admission in patients with COVID-19 and respiratory failure, and 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections. Methods This was a single-centre, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or nonconservative oxygen supplementation during helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target PaO2 <100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation. Results 71 patients were included in the conservative cohort and 75 in the nonconservative cohort. Mortality rate was lower in the conservative cohort (22.5% versus 62.7%; p<0.001). Rates of ICU admission and new-onset organ failure were lower in the conservative cohort (14.1% versus 37.3%; p=0.001 and 9.9% versus 45.3%; p<0.001, respectively). Conclusions In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during helmet CPAP was associated with improved survival, lower ICU admission rate and less new-onset organ failure.http://openres.ersjournals.com/content/9/2/00455-2022.full |
| spellingShingle | Alessandra Iacovelli Maria Luisa Nicolardi Valentina Baccolini Federica Olmati Ilenia Attilia Pia Baiocchi Letizia D'Antoni Ilaria Menichini Ambra Migliarini Daniela Pellegrino Angelo Petroianni Daniel Piamonti Angela Tramontano Paolo Villari Paolo Palange Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study ERJ Open Research |
| title | Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study |
| title_full | Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study |
| title_fullStr | Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study |
| title_full_unstemmed | Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study |
| title_short | Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study |
| title_sort | conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with covid 19 and respiratory failure a pilot study |
| url | http://openres.ersjournals.com/content/9/2/00455-2022.full |
| work_keys_str_mv | AT alessandraiacovelli conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT marialuisanicolardi conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT valentinabaccolini conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT federicaolmati conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT ileniaattilia conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT piabaiocchi conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT letiziadantoni conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT ilariamenichini conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT ambramigliarini conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT danielapellegrino conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT angelopetroianni conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT danielpiamonti conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT angelatramontano conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT paolovillari conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy AT paolopalange conservativeoxygensupplementationduringhelmetcontinuouspositiveairwaypressuretherapyinpatientswithcovid19andrespiratoryfailureapilotstudy |