Ramirez Giuseppe A, Bozzolo Enrica P, Castelli Elena, Marinosci Alessandro, Angelillo Piera, Damanti Sarah, Scotti Raffaella, Gobbi Agnese, Centurioni Clarissa, DI Scala Flavia, Morgillo Anna, Castagna Antonella, Conte Caterina, Assanelli Andrea, DE Cobelli Francesco, Calcaterra Barbara, Cabrini Luca, Carcò Francesco, Turi Stefano, Silvani Paolo, Dagna Lorenzo, Zangrillo Alberto, Landoni Giovanni, Tresoldi Moreno
Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy.
Vita-Salute San Raffaele University, Milan, Italy.
Minerva Med. 2022 Apr;113(2):281-290. doi: 10.23736/S0026-4806.20.06952-9. Epub 2020 Sep 30.
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
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.
大流行期间重症监护病房外持续气道正压通气和呼吸物理治疗的疗效与安全性。
在2020年2月至5月于米兰一家大型教学医院进行的这项队列研究中，对患有成人呼吸窘迫综合征的新冠肺炎患者进行随访，这些患者在重症监护病房外接受持续气道正压通气（呼气末正压=10 cm H₂O，吸入氧浓度=0.6，每日治疗时长：4×3小时周期）以及包括俯卧位通气在内的呼吸物理治疗。
90例在重症监护病房外接受持续气道正压通气治疗的急性呼吸窘迫综合征（ARDS）患者（45/90，50%至少进行过一次俯卧位通气），中位（四分位间距）随访时间为37（11 - 46）天，其中45例（50%）出院回家，28例（31%）仍住院，17例（19%）死亡。记录到35例（39%）患者出现持续气道正压通气失败。患者活动与失败率降低相关（P = 0.033）。未观察到安全问题。
在大流行期间，对于在重症监护病房外治疗的新冠肺炎所致ARDS患者，持续气道正压通气联合患者活动（包括俯卧位通气）有效且安全。
