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

Autor: Martina Piluso, Clarissa Ferrari, Silvia Pagani, Pierfranco Usai, Stefania Raschi, Luca Parachini, Elisa Oggionni, Chiara Melacini, Francesca D’Arcangelo, Roberta Cattaneo, Cristiano Bonacina, Monica Bernareggi, Serena Bencini, Marta Nadalin, Mara Borelli, Roberto Bellini, Maria Chiara Salandini, Paolo Scarpazza
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Advances in Respiratory Medicine, Vol 91, Iss 5, Pp 383-396 (2023)
Druh dokumentu: article
ISSN: 91050030
2543-6031
DOI: 10.3390/arm91050030
Popis: 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 (PaO2) and fraction of inspired oxygen (FiO2) PaO2/FiO2 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 PaO2/FiO2 (worst score) ratio in H-CPAP and to steroids’ administration. D-dimer at admission, FiO2 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: Directory of Open Access Journals
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