Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections

Crimi, Claudia; Noto, Alberto; Cortegiani, Andrea; Impellizzeri, Pietro; Elliott, Mark; Ambrosino, Nicolino; Gregoretti, Cesare

doi:10.23736/s0375-9393.20.14785-0

Cited by 41 publications

(48 citation statements)

References 76 publications

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“…One of the most used non-invasive respiratory support strategies is CPAP, especially if delivered by helmet [ 7 , 8 ]. CPAP allows increase of functional residual capacity and improving ventilation/perfusion matching (by re-inflating collapsed alveoli) [ 9 ]. CPAP application is also easier to be quickly set up in term of nursing time consumption as compared to NIV.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Guia

Boléo-Tomé

Imitazione

et al. 2021

Respiratory Medicine

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Introduction In COVID-19 associated hypoxemic acute respiratory failure (ARF) without mandatory indication for urgent endotracheal intubation, a trial of CPAP may be considered. We aimed to evaluate HACOR (heart rate, acidosis, consciousness, oxygenation, respiratory rate) score performance in these patients as predictor of CPAP failure. Methods Prospective observational multicentric study (three centers in different countries), including adult patients with SARS-CoV-2 pneumonia admitted to a respiratory intermediate care unit, presenting PaO 2 /FiO 2 < 300 and PaCO 2 < 45 mmHg, who received CPAP. One hour after starting CPAP, HACOR was calculated. Results We enrolled 128 patients, mean age 61,7 years. Mean HACOR at one hour after starting CPAP was 3,27 ± 3,84 and mean PaO 2 /FiO 2 was 203,30 ± 92,21 mmHg; 35 patients (27,3%) presented CPAP failure: 29 underwent oro-tracheal intubation and 6 died due to COVID-19 (all having a do-not-intubate order). HACOR accuracy for predicting CPAP failure was 82,03%, while PaO 2 /FiO2 accuracy was 81,25%. Conclusion Although HACOR score had a good diagnostic performance in predicting CPAP failure in COVID-19-related ARF, PaO 2 /FiO 2 has also shown to be a good predictor of failure.

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Section: Introductionmentioning

confidence: 99%

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Guia

Boléo-Tomé

Imitazione

et al. 2021

Respiratory Medicine

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“…COVID-19 is a recent, ongoing pandemic which has spread quickly, overwhelming hospitals and increasing demand for critical care services. It has a high mortality rate which ranges from 62% to 97% in patients requiring advanced respiratory support [1]. Against a background of serious urgency and uncertainty, the shortage of beds and the possibility of being hospitalised far from one's home have led to a great demand for home care.…”

Section: Introductionmentioning

confidence: 99%

Home Management of Patients with Moderate or Severe Respiratory Failure Secondary to COVID-19, Using Remote Monitoring and Oxygen with or without HFNC

et al. 2021

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Background: Home treatment of patients affected by COVID-19 is still a matter of daily debate. During the clinical evolution of the disease, there are high risks of lung failure, which requires oxygen therapy. Here, we report our clinical experience with at-home treatment using high-flow nasal cannula in non-hospitalised patients with confirmed COVID-19. Patients and methods: In this study, 18 patients with moderate-to-severe respiratory failure secondary to COVID-19 were monitored at home daily for temperature and SpO2 measurements. Other parameters such as saturation of peripheral oxygen (SpO2), SpO2/FiO2 (fraction of inspired oxygen), temperature, and lung performance were monitored periodically. Depending on oxygen requirements, the patients also received either standard oxygen via a face mask or, if higher FiO2 required, high-flow nasal cannula (HFNC). Results: All 18 patients had favourable outcomes and recovered from COVID-19. No death was recorded in this group. Conclusion: Our clinical experience proves that high-flow nasal cannula oxygen therapy may be considered for at-home treatment of COVID-19 patients with moderate lung failure. This could be useful for further treatment during the pandemic and may also be considered in future epidemics.

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“…8 Department of Medicina e Chirurgia, Università Insubria Varese-Como, Varese, Italy. 9 Pulmonary Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, Pavia, Italy. 10 ASL CN1, S.S.D.…”

Section: Openmentioning

confidence: 99%

“…Healthcare organizations have proactively implemented several strategies to supply shortages of equipment as demand surges, rationing life-saving treatments such as using shared mechanical ventilation 6 , establishing ventilator lottery or ventilator triage policies 7,8 , and increasing the use of NRS 9 . To address the high demand for NRS equipment exceeding the capacity, Food and Drug Administration issued an emergency policy allowing the use of home respiratory devices, such as Continuous Positive Airway Pressure (CPAP), as an alternative to life-saving ventilators 10 .…”

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confidence: 99%

Performance of EasyBreath Decathlon Snorkeling mask for delivering continuous positive airway pressure

Noto

Crimi

Cortegiani

et al. 2021

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During the COVID-19 pandemic, the need for noninvasive respiratory support devices has dramatically increased, sometimes exceeding hospital capacity. The full-face Decathlon snorkeling mask, EasyBreath (EB mask), has been adapted to deliver continuous positive airway pressure (CPAP) as an emergency respiratory interface. We aimed to assess the performance of this modified EB mask and to test its use during different gas mixture supplies. CPAP set at 5, 10, and 15 cmH2O was delivered to 10 healthy volunteers with a high-flow system generator set at 40, 80, and 120 L min−1 and with a turbine-driven ventilator during both spontaneous and loaded (resistor) breathing. Inspiratory CO2 partial pressure (PiCO2), pressure inside the mask, breathing pattern and electrical activity of the diaphragm (EAdi) were measured at all combinations of CPAP/flows delivered, with and without the resistor. Using the high-flow generator set at 40 L min−1, the PiCO2 significantly increased and the system was unable to maintain the target CPAP of 10 and 15 cmH2O and a stable pressure within the respiratory cycle; conversely, the turbine-driven ventilator did. EAdi significantly increased with flow rates of 40 and 80 L min−1 but not at 120 L min−1 and with the turbine-driven ventilator. EB mask can be safely used to deliver CPAP only under strict constraints, using either a high-flow generator at a flow rate greater than 80 L min−1, or a high-performance turbine-driven ventilator.

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Noninvasive respiratory support in acute hypoxemic respiratory failure associated with COVID-19 and other viral infections

Abstract: doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Cited by 41 publications

References 76 publications

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Usefulness of the HACOR score in predicting success of CPAP in COVID-19-related hypoxemia

Home Management of Patients with Moderate or Severe Respiratory Failure Secondary to COVID-19, Using Remote Monitoring and Oxygen with or without HFNC

Performance of EasyBreath Decathlon Snorkeling mask for delivering continuous positive airway pressure

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