Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia

The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP f...

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Autores principales:	Silvia Coppola, Pierachille Santus, Giovanni Sotgiu, Michele Mondoni, Alessia Gandola, Marina Saad, Giuseppe Francesco Sferrazza Papa, Stefano Centanni, Laura Saderi, Davide Alberto Chiumello, Dejan Radovanovic
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	COVID-19 noninvasive ventilation continuous positive airway pressure intubation mortality acute respiratory failure Medicine R
Acceso en línea:	https://doaj.org/article/f2081efd9b2b403dbb6d5c6681070255
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spelling	oai:doaj.org-article:f2081efd9b2b403dbb6d5c66810702552021-11-25T18:02:55ZFeasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia10.3390/jcm102254442077-0383https://doaj.org/article/f2081efd9b2b403dbb6d5c66810702552021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5444https://doaj.org/toc/2077-0383The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP failed. Secondary outcomes were in-hospital mortality and in-hospital length of stay (LOS). A retrospective, observational, multicenter study was conducted in intermediate-high dependency respiratory units of two Italian university hospitals. Consecutive patients with COVID-19 treated with CPAP were enrolled. Thoraco-abdominal asynchrony or hemodynamic instability led to ETI. Patients showing SpO<sub>2</sub> ≤ 94%, respiratory rate ≥ 30 bpm or accessory muscle activation on CPAP received NIV. Respiratory distress and desaturation despite NIV eventually led to ETI. 156 patients were included. The overall rate of ETI was 30%, mortality 18% and median LOS 24 (17–32) days. Among patients that failed CPAP (<i>n</i> = 63), 28% were intubated, while the remaining 72% received NIV, of which 65% were intubated. Patients intubated after CPAP showed lower baseline PaO<sub>2</sub>/FiO<sub>2</sub>, lower lymphocyte counts and higher D-dimer values compared with patients intubated after CPAP + NIV. Mortality was 22% with CPAP + ETI, and 20% with CPAP + NIV + ETI. In the case of CPAP failure, a NIV trial appears feasible, does not deteriorate respiratory status and may reduce the need for ETI in COVID-19 patients.Silvia CoppolaPierachille SantusGiovanni SotgiuMichele MondoniAlessia GandolaMarina SaadGiuseppe Francesco Sferrazza PapaStefano CentanniLaura SaderiDavide Alberto ChiumelloDejan RadovanovicMDPI AGarticleCOVID-19noninvasive ventilationcontinuous positive airway pressureintubationmortalityacute respiratory failureMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5444, p 5444 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	COVID-19 noninvasive ventilation continuous positive airway pressure intubation mortality acute respiratory failure Medicine R
spellingShingle	COVID-19 noninvasive ventilation continuous positive airway pressure intubation mortality acute respiratory failure Medicine R Silvia Coppola Pierachille Santus Giovanni Sotgiu Michele Mondoni Alessia Gandola Marina Saad Giuseppe Francesco Sferrazza Papa Stefano Centanni Laura Saderi Davide Alberto Chiumello Dejan Radovanovic Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia
description	The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP failed. Secondary outcomes were in-hospital mortality and in-hospital length of stay (LOS). A retrospective, observational, multicenter study was conducted in intermediate-high dependency respiratory units of two Italian university hospitals. Consecutive patients with COVID-19 treated with CPAP were enrolled. Thoraco-abdominal asynchrony or hemodynamic instability led to ETI. Patients showing SpO<sub>2</sub> ≤ 94%, respiratory rate ≥ 30 bpm or accessory muscle activation on CPAP received NIV. Respiratory distress and desaturation despite NIV eventually led to ETI. 156 patients were included. The overall rate of ETI was 30%, mortality 18% and median LOS 24 (17–32) days. Among patients that failed CPAP (<i>n</i> = 63), 28% were intubated, while the remaining 72% received NIV, of which 65% were intubated. Patients intubated after CPAP showed lower baseline PaO<sub>2</sub>/FiO<sub>2</sub>, lower lymphocyte counts and higher D-dimer values compared with patients intubated after CPAP + NIV. Mortality was 22% with CPAP + ETI, and 20% with CPAP + NIV + ETI. In the case of CPAP failure, a NIV trial appears feasible, does not deteriorate respiratory status and may reduce the need for ETI in COVID-19 patients.
format	article
author	Silvia Coppola Pierachille Santus Giovanni Sotgiu Michele Mondoni Alessia Gandola Marina Saad Giuseppe Francesco Sferrazza Papa Stefano Centanni Laura Saderi Davide Alberto Chiumello Dejan Radovanovic
author_facet	Silvia Coppola Pierachille Santus Giovanni Sotgiu Michele Mondoni Alessia Gandola Marina Saad Giuseppe Francesco Sferrazza Papa Stefano Centanni Laura Saderi Davide Alberto Chiumello Dejan Radovanovic
author_sort	Silvia Coppola
title	Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia
title_short	Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia
title_full	Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia
title_fullStr	Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia
title_full_unstemmed	Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia
title_sort	feasibility and clinical outcomes of a step up noninvasive respiratory support strategy in patients with severe covid-19 pneumonia
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/f2081efd9b2b403dbb6d5c6681070255
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Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia

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