Continuous positive airway pressure and pronation outside the Intensive Care Unit in COVID-19 acute respiratory distress syndrome.

Adult COVID-19 / complications Cohort Studies Continuous Positive Airway Pressure Humans Intensive Care Units Pronation Respiratory Distress Syndrome / therapy

Journal

Minerva medica

ISSN: 1827-1669

Titre abrégé: Minerva Med

Pays: Italy

ID NLM: 0400732

Informations de publication

Date de publication:
Apr 2022

Historique:

pubmed: 1 10 2020

medline: 18 5 2022

entrez: 30 9 2020

Statut: ppublish

Résumé

The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the Intensive Care Unit during a pandemic. In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure =10 cm H<inf>2</inf>O, FiO<inf>2</inf>=0.6, daily treatment duration: 4×3h-cycles) and respiratory physiotherapy including pronation outside the Intensive Care Unit were followed-up. Of 90 acute respiratory distress syndrome (ARDS) patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the Intensive Care Unit and with a median (interquartile) follow-up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (P=0.033). No safety issues were observed. Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the Intensive Care Unit setting during the pandemic.

Sections du résumé

BACKGROUND BACKGROUND

The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the Intensive Care Unit during a pandemic.

METHODS METHODS

In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure =10 cm H<inf>2</inf>O, FiO<inf>2</inf>=0.6, daily treatment duration: 4×3h-cycles) and respiratory physiotherapy including pronation outside the Intensive Care Unit were followed-up.

RESULTS RESULTS

Of 90 acute respiratory distress syndrome (ARDS) patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the Intensive Care Unit and with a median (interquartile) follow-up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (P=0.033). No safety issues were observed.

CONCLUSIONS CONCLUSIONS

Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the Intensive Care Unit setting during the pandemic.

Identifiants

DOI: 10.23736/S0026-4806.20.06952-9 PMID: 32996727

pubmed: 32996727

pii: S0026-4806.20.06952-9

doi: 10.23736/S0026-4806.20.06952-9

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

281-290

Investigateurs

Alessandro Belletti (A)

Elena Brioschi (E)

Stefania L Calvisi (SL)

Federica Cerri (F)

Mariapia Cicalese (M)

Marta Cilla (M)

Gustavo Corti (G)

Valentina DA Prat (V)

Giuseppe DI Lucca (G)

Mattia DI Meo (M)

Gaetano DI Terlizzi (G)

Giovanni Guarneri (G)

Salvatore Lavalle (S)

Sabina Martinenghi (S)

Sara Mastaglio (S)

Luis E Mendoza (LE)

Fabrizio Monaco (F)

Junaid Mushtaq (J)

Renato Pennella (R)

Simona Piemontese (S)

Raffaella Reineke (R)

Chiara Salmaggi (C)

Silvia Strada (S)

Stefano Tentori (S)

Mirta Tiraboschi (M)

Eugenio Ventimiglia (E)

Giordano Vitali (G)