We report a case in which life support for cardiogenic shock was achieved by a nonpulsatile venoarterial bypass, and left ventricular decompression was obtained by a catheter placed percutaneously through the aortic valve into the left ventricle. The blood drained from the left ventricle was pumped into the femoral artery. The normalization of left heart filling pressures allowed the resolution of pulmonary edema, and the patient underwent a successful heart transplantation following 7 days of mechanical cardiocirculatory support.
Continuous positive airway pressure (CPAP) has been successfully applied to patients with COVID-19 to prevent endotracheal intubation. However, experience of CPAP application in pregnant women with acute respiratory failure (ARF) due to SARS-CoV-2 pneumonia is scarce. This study aimed to describe the natural history and outcome of ARF in a cohort of pregnant women with SARS-CoV-2 pneumonia, focusing on the feasibility of helmet CPAP (h-CPAP) application and the variables related to ARF worsening. A retrospective, observational study enrolling 41 consecutive pregnant women hospitalised for SARS-CoV-2 pneumonia in a tertiary care center between March 2020 and March 2021. h-CPAP was applied if arterial partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) was inferior to 200 and/or patients had respiratory distress despite adequate oxygen supplementation. Characteristics of patients requiring h-CPAP vs those in room air or oxygen only were compared. Twenty-seven (66%) patients showed hypoxemic ARF requiring oxygen supplementation and h-CPAP was needed in 10 cases (24%). PaO2/FiO2 was significantly improved during h-CPAP application. The device was well-tolerated in all cases with no adverse events. Higher serum C reactive protein and more extensive (≥3 lobes) involvement at chest X-ray upon admission were observed in the h-CPAP group. Assessment of temporal distribution of cases showed a substantially increased rate of CPAP requirement during the third pandemic wave (January-March 2021). In conclusion, h-CPAP was feasible, safe, well-tolerated and improved oxygenation in pregnant women with moderate-to-severe ARF due to SARS-CoV-2 pneumonia. Moderate-to-severe ARF was more frequently observed during the third pandemic wave.
Background: COVID-19 Acute Respiratory Distress Syndrome (CARDS) is the major complication of COVID-19. The SARS-CoV-2 outbreaks rapidly saturating ICU beds, forcing the application of non-invasive respiratory support (NIRS) in respiratory intermediate care unit (RICU).Methods: 515 patients were enrolled in our observational prospective study based on CARDS developed in RICU during the three Italian pandemic waves (150, 180 and 185 patients respectively). All selected patients (aged 18-80) were treated with Helmet-Continuous Positive Airway Pressure (H-CPAP). The primary aim of the study is to compare the patients’ clinical characteristics and outcomes (H-CPAP success/failure and survival/death) during the three different pandemic waves. The secondary aim is to evaluate and detect the main predictors of the H-CPAP success and survival/death in patients selected by having CARDS criteria.Results: The worst ratio of arterial partial pressure of oxygen (PaO2) and fraction of inspired oxygen (FiO2) PaO2/FiO2 during H-CPAP stratified the subjects in mild (82-15.9%), moderate (202-39.2%) and severe (231-44.9%) 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 ratio PaO2/FiO2 (worst score) in H-CPAP and steroids administration. D-dimer at admission, FiO2 in H-CPAP, and level of PEEP were also associated with H-CPAP success.Conclusions: Our study suggests good clinical outcomes with H-CPAP in CARDS in RICU. CARDS has a biphasic trend confirmed in all the three waves, with a worsening patients’ trend from admission to subsequent days of hospitalization. A widespread use of steroids in our center could play a role in achieving good clinical outcomes. The proper management during hospitalization by pulmonologist in RICU may affect these patients’ trend. We observed a significant improvement of prognosis in the three different waves: patients are found to be progressively slightly less severe.
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