Effectiveness and safety of noninvasive positive pressure ventilation in the treatment of COVID-19-associated acute hypo
- PDF / 506,945 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 62 Downloads / 163 Views
IM - ORIGINAL
Effectiveness and safety of noninvasive positive pressure ventilation in the treatment of COVID‑19‑associated acute hypoxemic respiratory failure: a single center, non‑ICU setting experience Antonio Faraone1 · Chiara Beltrame1 · Andrea Crociani1 · Paolo Carrai1 · Elena Lovicu1 · Simona Filetti1 · Serena Sbaragli1 · Chiara Alessi1 · Michela Cameron Smith1 · Chiara Angotti1 · Alberto Fortini1 Received: 1 September 2020 / Accepted: 31 October 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract The role of noninvasive positive pressure ventilation (NIPPV) in COVID-19 patients with acute hypoxemic respiratory failure (AHRF) is uncertain, as no direct evidence exists to support NIPPV use in such patients. We retrospectively assessed the effectiveness and safety of NIPPV in a cohort of COVID-19 patients consecutively admitted to the COVID-19 general wards of a medium-size Italian hospital, from March 6 to May 7, 2020. Healthcare workers (HCWs) caring for COVID-19 patients were monitored, undergoing nasopharyngeal swab for SARS-CoV-2 in case of onset of COVID-19 symptoms, and periodic SARS-CoV-2 screening serology. Overall, 50 patients (mean age 74.6 years) received NIPPV, of which 22 (44%) were successfully weaned, avoiding endotracheal intubation (ETI) and AHRF-related death. Due to limited life expectancy, 25 (50%) of 50 NIPPV-treated patients received a “do not intubate” (DNI) order. Among these, only 6 (24%) were weaned from NIPPV. Of the remaining 25 NIPPV-treated patients without treatment limitations, 16 (64%) were successfully weaned, 9 (36%) underwent delayed ETI and, of these, 3 (33.3%) died. NIPPV success was predicted by the use of corticosteroids (OR 15.4, CI 1.79–132.57, p 0.013) and the increase in the PaO2/FiO2 ratio measured 24–48 h after NIPPV initiation (OR 1.02, CI 1–1.03, p 0.015), while it was inversely correlated with the presence of a DNI order (OR 0.03, CI 0.001–0.57, p 0.020). During the study period, 2 of 124 (1.6%) HCWs caring for COVID-19 patients were diagnosed with SARS-CoV-2 infection. Apart from patients with limited life expectancy, NIPPV was effective in a substantially high percentage of patients with COVID-19-associated AHRF. The risk of SARS-CoV-2 infection among HCWs was low. Keywords COVID-19 · Respiratory distress syndrome · adult · Noninvasive ventilation · Aerosol-generating procedures · Health personnel · Personal protective equipment
Introduction Within a span of months, the COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has seen a surge of patients with respiratory distress admitted to hospitals across the globe [1]. Patients presenting with COVID-19-associated acute hypoxemic respiratory failure (AHRF) despite conventional oxygen therapy commonly meet the criteria for acute respiratory distress syndrome (ARDS) and require ventilatory support. Across * Antonio Faraone [email protected]; [email protected] 1
Department of Internal Medicine, San Giovanni Di Dio Hospital, Via di
Data Loading...
