Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

Aliberti, Stefano; Radovanovic, Dejan; Billi, Filippo; Sotgiu, Giovanni; Costanzo, Matteo; Pilocane, Tommaso; Saderi, Laura; Gramegna, Andrea; Rovellini, A.; Perotto, Luca; Monzani, Valter; Santus, Pierachille; Blasi, Francesco

doi:10.1183/13993003.01935-2020

Cited by 134 publications

(228 citation statements)

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“…In this study, patients were less hypoxemic than in our cohort at CPAP initiation (PaO2/FiO2 < 300 mmHg). The helmet interface was well tolerated with discontinuation in only 4 patients [29].…”

Section: Plos Onementioning

confidence: 98%

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

et al. 2020

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Section: Plos Onementioning

confidence: 98%

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

et al. 2020

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“…14 CPAP failure after 2 hours with the maximal tolerable PEEP and a FiO2 of 100% was considered in case of: a) persistence of PaO2/FiO2 <300 mm Hg; b) haemodynamic instability (systolic blood pressure <90 mm Hg despite adequate fluid support) or altered consciousness; d) respiratory distress, fatigue and/or a respiratory rate >30 bpm. 20 Patients who fulfilled CPAP failure criteria were evaluated by an ICU physician for potential intubation. A do not intubate (DNI) order was established by the treating attending physician following a multidisciplinary discussion with the unit staff and the ICU and based on patient's age, comorbidities and clinical status.…”

Section: Management Of Respiratory Failurementioning

confidence: 99%

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study

et al. 2020

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ObjectivesCOVID-19 causes lung parenchymal and endothelial damage that lead to hypoxic acute respiratory failure (hARF). The influence of hARF severity on patients’ outcomes is still poorly understood.DesignObservational, prospective, multicentre study.SettingThree academic hospitals in Milan (Italy) involving three respiratory high dependency units and three general wards.ParticipantsConsecutive adult hospitalised patients with a virologically confirmed diagnosis of COVID-19. Patients aged <18 years or unable to provide informed consent were excluded.InterventionsAnthropometrical, clinical characteristics and blood biomarkers were assessed within the first 24 hours from admission. hARF was graded as follows: severe (partial pressure of oxygen to fraction of inspired oxygen ratio (PaO2/FiO2) <100 mm Hg); moderate (PaO2/FiO2 101–200 mm Hg); mild (PaO2/FiO2 201–300 mm Hg) and normal (PaO2/FiO2 >300 mm Hg).Primary and secondary outcome measuresThe primary outcome was the assessment of clinical characteristics and in-hospital mortality based on the severity of respiratory failure. Secondary outcomes were intubation rate and application of continuous positive airway pressure during hospital stay.Results412 patients were enrolled (280 males, 68%). Median (IQR) age was 66 (55–76) years with a PaO2/FiO2 at admission of 262 (140–343) mm Hg. 50.2% had a cardiovascular disease. Prevalence of mild, moderate and severe hARF was 24.4%, 21.9% and 15.5%, respectively. In-hospital mortality proportionally increased with increasing impairment of gas exchange (p<0.001). The only independent risk factors for mortality were age ≥65 years (HR 3.41; 95% CI 2.00 to 5.78, p<0.0001), PaO2/FiO2 ratio ≤200 mm Hg (HR 3.57; 95% CI 2.20 to 5.77, p<0.0001) and respiratory failure at admission (HR 3.58; 95% CI 1.05 to 12.18, p=0.04).ConclusionsA moderate-to-severe impairment in PaO2/FiO2 was independently associated with a threefold increase in risk of in-hospital mortality. Severity of respiratory failure is useful to identify patients at higher risk of mortality.Trial registration numberNCT04307459

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“…The incidence of severely hypoxic patients was markedly reduced by helmet CPAP (Figure 1a, P<0.001 by Chi-Square); the PaO 2 /FiO 2 ratio improvement was more pronounced among more severely hypoxic patients (Figure 1b, P<0.001 for helmet CPAP effect and for its interaction with hypoxia severity class by RM Anova). A clinically signi cant reduction of respiratory rate was also present (from 28 [22][23][24][25][26][27][28][29][30][31][32] to 24 [20][21][22][23][24][25][26][27][28][29] BPM, P<0.001). After beginning of helmet CPAP, 71% of patients presented ARDS criteria (severe 9%; moderate 35%; mild 27%).…”

Section: Helmet Cpap Treatmentmentioning

confidence: 99%

“…[17][18][19] In a multicenter cohort study Aliberti et al showed that helmet CPAP signi cantly increased PaO2/FiO2 from oxygen administration alone, but that treatment failure was frequent, occurring in 44% of patients who required intubation and invasive ventilation. [20] Early recognition of patients at high risk of treatment failure is crucial, both for individual treatment and resources allocation. We present the outcomes associated with treatment of respiratory failure with helmet CPAP during the COVID-19 outbreak in our hospital consortium, an approach which has been widely applied in Northern Italy.…”

Section: Introductionmentioning

confidence: 99%

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Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

Coppadoro

Benini

Fruscio

et al. 2020

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Background: Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may threaten healthcare systems hold, due to the surge patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe hypoxia. Helmet is as effective interface to provide Continuous Positive Airway Pressure (CPAP) non-invasively. We report data about the usefulness of helmet CPAP during pandemic, either as an effective treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e. non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, since. CPAP failure was defined as a composite outcome of intubation or death.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full-treatment and 29% of the DNI patients (P<0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P<0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P<0.001). CPAP failure was independently associated with CRP, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wardsConclusions: Helmet CPAP treatment is feasible for several days outside the ICU, despite persisting hypoxia. It is effective, avoiding intubation in the majority of full treatment patients when standard oxygen therapy fails. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992

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Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

Cited by 134 publications

References 11 publications

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study

Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

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Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

Cited by 134 publications

References 11 publications

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study

Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study

Helmet CPAP&nbsp;to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak

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Helmet CPAP to Treat Hypoxic Pneumonia Outside the ICU: An Observational Study During the COVID-19 Outbreak