Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department

Privitera, Daniele; Angaroni, Laura; Capsoni, Nicolò; Forni, Elisa; Pierotti, Federico; Vincenti, Fabrizio; Bellone, Andrea

doi:10.1007/s11739-020-02370-8

Cited by 33 publications

(33 citation statements)

References 16 publications

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“…Noninvasive strategies such as bilevel positive airway pressure were used in less than 10% of cases due to the potential risk of viral aerosolization [ 35 ]. Other countries used non-invasive ventilation treatments more liberally and some research suggests a possible benefit [ 36 ]. In a Chinese study of 113 fatalities, only 6% of patients received invasive treatment compared to 37% receiving noninvasive ventilation [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort

et al. 2020

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Coronavirus disease (COVID-19) has aggressively spread across the United States with numerous fatalities. Risk factors for mortality are poorly described. This was a multicentered cohort study identifying patient characteristics and diagnostic markers present on initial evaluation associated with mortality in hospitalized COVID-19 patients. Epidemiological, demographic, clinical, and laboratory characteristics of survivors and non-survivors were obtained from electronic medical records and a multivariable survival regression analysis was conducted to identify risk factors of in-hospital death. Of 1629 consecutive hospitalized adult patients with confirmed COVID-19 from March 1st thru March 31, 2020, 1461 patients were included in final analysis. 327 patients died during hospitalization and 1134 survived to discharge. Median age was 62 years (IQR 50.0, 74.0) with 56% of hospitalized patients under the age of 65. 47% were female and 63% identified as African American. Most patients (55%) had either no or one comorbidity. In multivariable analysis, older age, admission respiratory status including elevated respiratory rate and oxygen saturation ≤ 88%, and initial laboratory derangements of creatinine > 1.33 mg/dL, alanine aminotransferase > 40 U/L, procalcitonin > 0.5 ng/mL, and lactic acid ≥ 2 mmol/L increased risk of in-hospital death. This study is one of the largest analyses in an epicenter for the COVID-19 pandemic. Older age, low oxygen saturation and elevated respiratory rate on admission, and initial lab derangements including renal and hepatic dysfunction and elevated procalcitonin and lactic acid are risk factors for in-hospital death. These factors can help clinicians prognosticate and should be considered in management strategies.

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Section: Discussionmentioning

confidence: 99%

Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort

et al. 2020

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“…The mortality rate was similar to other studies populations even if a comparison is not easy due to differences in disease severity among different studies groups. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] A signi cant difference in the median length of hospital stay hospital resulted between ETI and non-ETI patients, 26 days [IQR 16-37] vs 15 days [IQR 9-17] respectively (p = 0.005), certainly due, in addition to initial patients' severity, to complications related to IMV and ICUs stay.…”

Section: Discussionmentioning

confidence: 99%

“…A local protocol was drawn up to standardize a rst trial of CPAP, and only patients who strictly respect the protocol were considered. 13 STROBE guidelines for reporting observational studies were followed. 14…”

Section: Study Design and Settingmentioning

confidence: 99%

CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department

Capsoni¹,

Privitera²,

Mazzone³

et al. 2020

Preprint

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Background During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Methods A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. Results A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16–37] vs 15 days [IQR 9–17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7–21] with an ICU length of stay of 14.5 days [IQR 10–28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059). Conclusionss A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient’s RR reduction. More studies are needed to evaluate the efficacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.

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“…to provide useful practical information to avoid waste of ICU resources. Bellone and collaborators propose helmet CPAP for non-responders to conventional oxygen (5 liters per minute for 10 -15 minutes) [28], clinically monitoring every 30 minutes for the first two hours, gradually increasing PEEP from 7.5 cmH2O to 12.5 if the goal is not reached (SpO2 > 94%, RR < 25 bpm). In case of improvement CPAP is continued, possibly alternating intervals with HFNC; with no improvement the patient is selected for tracheal intubation or palliative treatment.…”

Section: Tablementioning

confidence: 99%

Non-invasive respiratory support in the treatment of acute hypoxemic respiratory failure secondary to CoViD-19 related pneumonia

Groff

Ferrari²

2021

European Journal of Internal Medicine

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In the last 11 months, the SARS-CoV-2 pandemic has overwhelmed and disrupted the whole world in health, social and economic terms. We are progressively learning more and more about the epidemiological and clinical features that distinguish CoViD-19 from any previous experience in the emergency and critical care setting. Experiences are multiplying with regard to the use of non-invasive respiratory support techniques in the context of acute hypoxemic respiratory failure secondary to CoViD-19-related pneumonia. Doubts still far outweigh certainties, but a growing series of mostly monocentric and retrospective studies are becoming available as concrete decision-making and operational support for healthcare workers. In this review the available studies and experiences about non-invasive respiratory support in the treatment of Covid-19 related respiratory failure, mainly coming from outside the ICU setting, will be discussed.

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Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department

Cited by 33 publications

References 16 publications

Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort

Early predictors of in-hospital mortality in patients with COVID-19 in a large American cohort

CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department

Non-invasive respiratory support in the treatment of acute hypoxemic respiratory failure secondary to CoViD-19 related pneumonia

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