COVID-19 Acute Respiratory Distress Syndrome: Treatment with Helmet CPAP in Respiratory Intermediate Care Unit by Pulmonologists in the Three Italian Pandemic Waves.

Autor:	Piluso M; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Ferrari C; Research and Clinical Trials Office, Poliambulanza Foundation Hospital, 25124 Brescia, Italy., Pagani S; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Usai P; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Raschi S; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Parachini L; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Oggionni E; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Melacini C; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., D'Arcangelo F; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Cattaneo R; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Bonacina C; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Bernareggi M; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Bencini S; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Nadalin M; School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy.; Cardiothoracic Vascular Department, Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy., Borelli M; School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy.; Cardiothoracic Vascular Department, Respiratory Unit, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy., Bellini R; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Salandini MC; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy., Scarpazza P; Lung Unit, Cardiothoracic Vascular Department, Vimercate Hospital, 20871 Vimercate, Italy.
Jazyk:	angličtina
Zdroj:	Advances in respiratory medicine [Adv Respir Med] 2023 Sep 20; Vol. 91 (5), pp. 383-396. Date of Electronic Publication: 2023 Sep 20.
DOI:	10.3390/arm91050030
Abstrakt:	COVID-19 Acute Respiratory Distress Syndrome (CARDS) is the most serious complication of COVID-19. The SARS-CoV-2 outbreaks rapidly saturated intensive care unit (ICU), forcing the application of non-invasive respiratory support (NIRS) in respiratory intermediate care unit (RICU). The primary aim of this study is to compare the patients' clinical characteristics and outcomes (Helmet-Continuous Positive Airway Pressure (H-CPAP) success/failure and survival/death). The secondary aim is to evaluate and detect the main predictors of H-CPAP success and survival/death. A total of 515 patients were enrolled in our observational prospective study based on CARDS developed in RICU during the three Italian pandemic waves. All selected patients were treated with H-CPAP. The worst ratio of arterial partial pressure of oxygen (PaO 2 ) and fraction of inspired oxygen (FiO 2 ) PaO 2 /FiO 2 during H-CPAP stratified the subjects into mild, moderate and severe CARDS. H-CPAP success has increased during the three waves (62%, 69% and 77%, respectively) and the mortality rate has decreased (28%, 21% and 13%). H-CPAP success/failure and survival/death were related to the PaO 2 /FiO 2 (worst score) ratio in H-CPAP and to steroids' administration. D-dimer at admission, FiO 2 and positive end expiratory pressure (PEEP) were also associated with H-CPAP success. Our study suggests good outcomes with H-CPAP in CARDS in RICU. A widespread use of steroids could play a role.
Databáze:	MEDLINE
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