Continuous positive airway pressure and pronation outside the Intensive Care Unit in COVID-19 acute respiratory distress syndrome

Ramirez, Giuseppe A.; Bozzolo, Enrica; Castelli, E; Marinosci, A; Angelillo, Piera; Damanti, Sarah; Scotti, Raffaella; Gobbi, Agnese; Centurioni, Clarissa; Scala, Flavia Di; Morgillo, Anna; Castagna, Antonella; Conte, Caterina; Assanelli, Andrea; Cobelli, Francesco De; Calcaterra, Barbara; Cabrini, Luca; Carcò, Francesco; Túri, Sándor; Silvani, Paolo; Dagna, Lorenzo; Zangrillo, Alberto; Landoni, Giovanni; Tresoldi, Moreno

doi:10.23736/s0026-4806.20.06952-9

Cited by 29 publications

(21 citation statements)

References 38 publications

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“…Details on hospital organization and patients management in ICU and general wards have been previously published. 4,[20][21][22][24][25][26] Invasive mechanical ventilation, fluid and pharmacological management of patients were performed according to international guidelines and experts recommendations. [27][28][29][30][31] Briefly, we aimed for a tidal volume of 6-8 mL/kg of ideal body weight, a driving pressure of ≤ 15 cmH 2 O, and a pH > 7.25.…”

Section: Patients Managementmentioning

confidence: 99%

“…the most severely ill patients) while the long term outcome of patients treated with non-invasive ventilation is currently under investigation. 24,70,71 Patients included in our study were relatively young, prevalently male, with normal BMI and few comorbidities. Older patients with greater burden of comorbidities were less likely to be admitted to ICU during pandemic crisis 24,71 , and had higher risk of death.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

“…24,70,71 Patients included in our study were relatively young, prevalently male, with normal BMI and few comorbidities. Older patients with greater burden of comorbidities were less likely to be admitted to ICU during pandemic crisis 24,71 , and had higher risk of death. Therefore, our data may suffer from selection, gender and survival bias.…”

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

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One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation

Zangrillo

Belletti

Palumbo

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Patients Managementmentioning

confidence: 99%

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

Section: Strengths and Limitations Of The Studymentioning

confidence: 99%

See 1 more Smart Citation

One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation

Zangrillo

Belletti

Palumbo

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

View full text Add to dashboard Cite

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“…However, there was a small increase in the number of serious adverse events with CPAP compared with conventional oxygen therapy [ 56 ]. On the other hand, one small RCT and several cohort studies have shown that continuous CPAP therapy is not successful for all patients, and failure rates are higher when the treatment ceiling excludes IMV, such as when treating elderly patients who have many comorbidities [ 55 , 57 , 58 , 59 , 60 , 61 , 62 ]. Continuous CPAP has particularly beneficial effects on respiratory rate and oxygenation levels, and the majority of patients with COVID-19 who are offered continuous CPAP therapy (83–97%) are able to tolerate the treatment [ 57 , 63 ].…”

Section: Continuous Positive Airway Pressurementioning

confidence: 99%

Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation

et al. 2021

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Patients admitted to hospital with coronavirus disease 2019 (COVID-19) may develop acute respiratory failure (ARF) with compromised gas exchange. These patients require oxygen and possibly ventilatory support, which can be delivered via different devices. Initially, oxygen therapy will often be administered through a conventional binasal oxygen catheter or air-entrainment mask. However, when higher rates of oxygen flow are needed, patients are often stepped up to high-flow nasal cannula oxygen therapy (HFNC), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or invasive mechanical ventilation (IMV). BiPAP, CPAP, and HFNC may be beneficial alternatives to IMV for COVID-19-associated ARF. Current evidence suggests that when nasal catheter oxygen therapy is insufficient for adequate oxygenation of patients with COVID-19-associated ARF, CPAP should be provided for prolonged periods. Subsequent escalation to IMV may be implemented if necessary.

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“…A second major weakness in response to the crisis was the inability of health care services to provide respiratory support to a wide number of patients concentrated in very short timeframes coinciding with contagion surges. Non-invasive mechanical ventilation (NIV) proved successful as an alternative life support tool, even in patients with acute respiratory distress syndrome (ARDS), when intensive care units were overwhelmed [ 7 , 8 ]. Little is however known to date about the potential predictors of poor respiratory and survival outcome in patients with COVID-19 treated with NIV.…”

Section: Introductionmentioning

confidence: 99%

Frailty as a predictor of mortality in COVID-19 patients receiving CPAP for respiratory insufficiency

et al. 2022

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Objective Exploring the association between frailty and mortality in a cohort of patients with COVID-19 respiratory insufficiency treated with continuous positive airway pressure. Methods Frailty was measured using a Frailty Index (FI) created by using the baseline assessment data on comorbidities and body mass index and baseline blood test results (including pH, lactate dehydrogenase, renal and liver function, inflammatory indexes and anemia). FI > 0.25 identified frail individuals. Results Among the 159 included individuals (81% men, median age of 68) frailty was detected in 69% of the patients (median FI score 0.3 ± 0.08). Frailty was associated to an increased mortality (adjusted HR 1.99, 95% CI 1.02–3.88, p = 0.04). Conclusions Frailty is highly prevalent among patients with COVID-19, predicts poorer outcomes independently of age. A personalization of care balancing the risk and benefit of treatments (especially the invasive ones) in such complex patients is pivotal. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02070-z.

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Continuous positive airway pressure and pronation outside the Intensive Care Unit in COVID-19 acute respiratory distress syndrome

Cited by 29 publications

References 38 publications

One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation

One-Year Multidisciplinary Follow-Up of Patients With COVID-19 Requiring Invasive Mechanical Ventilation

Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation

Frailty as a predictor of mortality in COVID-19 patients receiving CPAP for respiratory insufficiency

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