Acute Improvements of Oxygenation with Cpap and Clinical Outcomes in Severe COVID-19 Pneumonia: A Multicenter, Retrospective Study

Pini, Stefano; Radovanovic, Dejan; Saad, Marina; Gatti, Marina; Danzo, Fiammetta; Mondoni, Michele; Aliberti, Stefano; Centanni, Stefano; Blasi, Francesco; Chiumello, Davide; Santus, Pierachille

doi:10.3390/jcm11237186

Cited by 3 publications

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“…In patients with hypoxemic ARF from COVID-19, CPAP has been demonstrated to provide better results in terms of intubation rate [ 135 , 136 ], especially in patients with limitations of care (such as patients with a “do not intubate” order) [ 137 ] relative to standard oxygen therapy. However, the largest trial comparing CPAP with oxygen therapy [ 135 ] did not report any benefit in terms of mortality.…”

Section: Management Of Acute Dyspnea With Non-invasive Respiratory Su...mentioning

confidence: 99%

Acute dyspnea in the emergency department: a clinical review

et al. 2023

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Acute dyspnea represents one of the most frequent symptoms leading to emergency room evaluation. Its significant prognostic value warrants a careful evaluation. The differential diagnosis of dyspnea is complex due to the lack of specificity and the loose association between its intensity and the severity of the underlying pathological condition. The initial assessment of dyspnea calls for prompt diagnostic evaluation and identification of optimal monitoring strategy and provides information useful to allocate the patient to the most appropriate setting of care. In recent years, accumulating evidence indicated that lung ultrasound, along with echocardiography, represents the first rapid and non-invasive line of assessment that accurately differentiates heart, lung or extra-pulmonary involvement in patients with dyspnea. Moreover, non-invasive respiratory support modalities such as high-flow nasal oxygen and continuous positive airway pressure have aroused major clinical interest, in light of their efficacy and practicality to treat patients with dyspnea requiring ventilatory support, without using invasive mechanical ventilation. This clinical review is focused on the pathophysiology of acute dyspnea, on its clinical presentation and evaluation, including ultrasound-based diagnostic workup, and on available non-invasive modalities of respiratory support that may be required in patients with acute dyspnea secondary or associated with respiratory failure.

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Section: Management Of Acute Dyspnea With Non-invasive Respiratory Su...mentioning

confidence: 99%

Acute dyspnea in the emergency department: a clinical review

et al. 2023

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“…Non-invasive respiratory systems (NIRS) can improve oxygenation and reduce the need for IMV by increasing functional residual capacity, reducing work of breathing, and recruiting nonaerated alveoli but clinical response is difficult to be predicted by changes in commonly used gas exchange indexes [ 12 ] and by previously validated prognostic scores. Retrospective ICUs data across 2020–2021 report that NIRS have been increasingly used and independently associated with improved survival, HR 0.59 [95% CI 0.54–0.65], p < 0.001) [ 13 ].…”

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confidence: 99%

Clinical Characteristics and Outcomes of Patients with Acute Respiratory Failure Due to SARS-CoV-2 Interstitial Pneumonia Treated with CPAP in a Medical Intermediate Care Setting: A Retrospective Observational Study on Comparison of Four Waves

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Bettini

et al. 2023

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Background: In COVID-19 patients non-invasive-positive-pressure-ventilation (NIPPV) has held a challenging role to reduce mortality and the need for invasive mechanical ventilation (IMV). The aim of this study was to compare the characteristics of patients admitted to a Medical Intermediate Care Unit for acute respiratory failure due to SARS-CoV-2 pneumonia throughout four pandemic waves. Methods: The clinical data of 300 COVID-19 patients treated with continuous positive airway pressure (CPAP) were retrospectively analysed, from March-2020 to April-2022. Results: Non-survivors were older and more comorbid, whereas patients transferred to ICU were younger and had fewer pathologies. Patients were older (from 65 (29–91) years in I wave to 77 (32–94) in IV, p < 0.001) and with more comorbidities (from Charlson’s Comorbidity Index = 3 (0–12) in I to 6 (1–12) in IV, p < 0.001). No statistical difference was found for in-hospital mortality (33.0%, 35.8%, 29.6% and 45.9% in I, II, III and IV, p = 0.216), although ICU-transfers rate decreased from 22.0% to 1.4%. Conclusions: COVID-19 patients have become progressively older and with more comorbidities even in critical care area; from risk class analyses by age and comorbidity burden, in-hospital mortality rates remain high and are thus consistent over four waves while ICU-transfers have significantly reduced. Epidemiological changes need to be considered to improve the appropriateness of care.

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