Paternoster G, Sartini C, Pennacchio E, Lisanti F, Landoni G, Cabrini L
Cardiovascular Anesthesia and ICU, San Carlos Regional Hospital (San Carlo Azienda Ospedaliera Regionale), Potenza, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Med Intensiva (Engl Ed). 2020 Sep 6;46(2):65-71. doi: 10.1016/j.medin.2020.08.008.
Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation.
Case series.
High dependency unit of San Carlo University Hospital (Potenza, Italy).
Eleven consecutive patients with COVID-19 ARDS.
Helmet CPAP in prone position after failing a CPAP trial in the supine position.
Data collection at baseline and then after 24, 48 and 72h of pronation. We measured PaO/FIO, pH, lactate, PaCO, SpO, respiratory rate and the status of the patients at 28-day follow up.
Patients were treated with helmet CPAP for a mean±SD of 7±2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO/FIO improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72h (p<.001). We also observed a significantly increase in Sp0 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU.
Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO/FIO, SpO and a reduction in respiratory rate.
持续气道正压通气（CPAP）是新型冠状病毒肺炎急性呼吸窘迫综合征（ARDS）的一种重要治疗手段，因为它能改善氧合、降低呼吸频率，并可避免气管插管和入住重症监护病房（ICU）。俯卧位时使用CPAP的情况鲜有描述，而在镇静期间使用CPAP则从未有过报道。
病例系列研究。
圣卡罗大学医院（意大利波坦察）的高依赖病房。
11例连续性新型冠状病毒肺炎ARDS患者。
在仰卧位CPAP试验失败后，采用头盔式CPAP进行俯卧位通气。
在基线时以及俯卧位通气24、48和72小时后收集数据。我们测量了动脉血氧分压/吸入氧分数值（PaO₂/FiO₂）、pH值、乳酸、动脉血二氧化碳分压（PaCO₂）、血氧饱和度（SpO₂）、呼吸频率以及患者在28天随访时的状况。
患者接受头盔式CPAP治疗的平均时间为7±2.7天。所有患者均可行俯卧位通气，但其中7例使用右美托咪定可提高舒适度。PaO₂/FiO₂从开始俯卧位通气前的107.5±20.8升至72小时后的244.4±106.2（p<0.001）。我们还观察到SpO₂显著升高，从90.6±2.3升至96±3.1（p<0.001），呼吸频率降低，从27.
