Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study

Abstract

Background. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory indexes as possible predictors of CPAP failure in ARF due to COVID-19. Methods. This was a multicenter, prospective, observational, and cohort study conducted in the respiratory units of three University hospitals in Milan and in a secondary care hospital in Codogno (Italy), on consecutive adult patients with ARF due to COVID-19 pneumonia that underwent CPAP between March 2020 and March 2021. ETI transfer to the intensive care unit or death is defined CPAP failure. Predictors of CPAP failure were assessed before T0 and 1 hour after T1 CPAP initiation and included mROX index (ratio of PaO2/FiO2 to respiratory rate), alveolar-to-arterial (A-a) O2 gradient, and the HACOR (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) score. Results. Three hundred and fifty four patients (mean age 64 years, 73% males) were included in the study; 136 (38.4%) satisfied criteria for CPAP failure. A-a O2 gradient, mROX, and HACOR scores were worse in patients who failed CPAP, both at T0 and T1 ( p < 0.001 for all parameters). The HACOR score was associated with CPAP failure (odds ratio—OR—for every unit increase in HACOR = 1.361; 95%CI: 1.103–1.680; p = 0.004 ; AUROC = 0.742; p < 0.001 ). CPAP failure was best predicted by a threshold of 4.50 (sensitivity = 53% and specificity = 87%). Conclusions. The HACOR score may be a reliable and early predictor of CPAP failure in patients treated for ARF in COVID-19 pneumonia.

Role of prognostic scores in predicting in-hospital mortality and failure of non-invasive ventilation in adults with COVID-19

“…[ 13 ] are both based on parameters easily obtainable at the bedside. The prognostic performance of the HACOR score has already been tested among COVID subjects, but it was tested only in the first hours after the beginning of the treatment with NIV and its prognostic value has been confirmed [ 30 , 31 ]. Its good prognostic stratification ability could be ascribed to the combination of parameters expressing oxygenation status, the degree of respiratory distress and the global clinical severity.…”

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

“…9 At the moment, only pilot studies have explored it, as for example, the use of Lactate, Oxygenation and Temperature score, 58 Single Breath Counting Test 59 and heart rate, acidosis, consciousness, oxygenation, respiratory rate. 60 However, until future research provides clinically significant evidence of these measures a systems-based approach should be preferred. 19 We have confirmed the positive effect of CPAP although these analyses have their own limitations in the number of considered confounders, which require further consideration 18 61 and the fact that not all COVID-19 patients can be treated with CPAP.…”

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

“…CPAP failure was defined as either death in the HDRU or the need for ETI and subsequent transfer to the intensive care unit [ 7 ].…”