Outcomes of noninvasive ventilation as the ceiling of treatment in patients with COVID-19.

Humans Aged Noninvasive Ventilation / adverse effects Respiration, Artificial COVID-19 / therapy Respiratory Insufficiency / therapy Continuous Positive Airway Pressure

Journal

Panminerva medica

ISSN: 1827-1898

Titre abrégé: Panminerva Med

Pays: Italy

ID NLM: 0421110

Informations de publication

Date de publication:
Dec 2022

Historique:

pubmed: 17 4 2021

medline: 21 12 2022

entrez: 16 4 2021

Statut: ppublish

Résumé

Non-invasive mechanical ventilation (NIV) is effective for symptom relief and respiratory support in patients with respiratory insufficiency, severe comorbidities and no indication to intubation. Experience with NIV as the ceiling of treatment in severely compromised novel coronavirus disease (COVID-19) patients is lacking. We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment. Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multiorgan insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign hematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12 h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h. NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment.

RESULTS RESULTS

Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multiorgan insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign hematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12 h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h.

CONCLUSIONS CONCLUSIONS

NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.

Identifiants

DOI: 10.23736/S0031-0808.21.04280-4 PMID: 33860653

pubmed: 33860653

pii: S0031-0808.21.04280-4

doi: 10.23736/S0031-0808.21.04280-4

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

506-516

Investigateurs

Jubin Abutalebi (J)

Stefania Acerno (S)

Piera Angelillo (P)

Chiara Asperti (C)

Andrea Assanelli (A)

Michele Bailo (M)

Matteo Bellone (M)

Luca Benassi (L)

Ambra Bertola (A)

Nicola Boffini (N)

Giovanni Borghi (G)

Emanuele Bosi (E)

Elena Brioschi (E)

Luca Cabrini (L)

Laura Cacciaguerra (L)

Stefania L Calvisi (SL)

Diana Canetti (D)

Valentina Cantoni (V)

Amelia Caretto (A)

Antonella Castagna (A)

Jacopo Castellani (J)

Ludovica Cavallo (L)

Federica Cerri (F)

Maria-Pia Cicalese (MP)

Fabio Ciceri (F)

Marta Cilla (M)

Elena Cinel (E)

Salvatore Colandonio (S)

Anna Colarieti (A)

Sergio Colombo (S)

Caterina Conte (C)

Gustavo Corti (G)

Lorenzo Dagna (L)

Teresa D'Aliberti (T)

Alberto Davalli (A)

Rebecca DE Lorenzo (R)

Luigi DI Filippo (L)

Antonio Esposito (A)

Nicola Farina (N)

Daniela Febres (D)

Renato Finazzi (R)

Claudia Frangi (C)

Giulio Frontino (G)

Filippo Gagliardi (F)

Bruno N Germinario (BN)

Giovanni Gobbin (G)

Giovanni Guarneri (G)

Matteo Impellizzeri (M)

Marco Lanzillotta (M)

Andrea Laurenzi (A)

Salvatore Lavalle (S)

Raffaele Li Voti (R)

Gaetano Lombardi (G)

Ignazio D Lopez (ID)

Nicolò Maimeri (N)

Gaia Mancuso (G)

Emanuela Manzo (E)

Francesco Marcialis (F)

Sabina Martinenghi (S)

Carlo M Martinenghi (CM)

Andrea Mastrangelo (A)

Massimo Memoli (M)

Roberta Mennella (R)

Chiara Molinari (C)

Giacomo Monti (G)

Luca Moroni (L)

Junaid Mushtaq (J)

Carlotta Notte (C)

Alessandro Ortalda (A)

Roberta Pajno (R)

Diego Palumbo (D)

Pietro Panni (P)

Maria Pascali (M)

Marcella Pasetti (M)

Renato Pennella (R)

Simona Piemontese (S)

Andrea Poli (A)

Antonella Poloniato (A)

Patrizia Rovere-Querini (P)

Annalisa Ruggeri (A)

Chiara Salmaggi (C)

Francesca Sangalli (F)

Paola Sgaramella (P)

Paolo Silvani (P)

Daniele Soddu (D)

Stephanie Steidler (S)

Silvia Strada (S)

Elena Tambaro (E)

Stefano Tentori (S)

Mirta Tiraboschi (M)

Stefania Vadruccio (S)

Eugenio Ventimiglia (E)

Giordano P Vitali (GP)

Matteo Vitali (M)

Mona-Rita Yacoub (MR)