Vaschetto Rosanna, Barone-Adesi Francesco, Racca Fabrizio, Pissaia Claudio, Maestrone Carlo, Colombo Davide, Olivieri Carlo, De Vita Nello, Santangelo Erminio, Scotti Lorenza, Castello Luigi, Cena Tiziana, Taverna Martina, Grillenzoni Luca, Moschella Maria Adele, Airoldi Gianluca, Borrè Silvio, Mojoli Francesco, Della Corte Francesco, Baggiani Marta, Baino Sara, Balbo Piero, Bazzano Simona, Bonato Valeria, Carbonati Sara, Crimaldi Federico, Daffara Veronica, De Col Luca, Maestrone Matteo, Malerba Mario, Moroni Federica, Perucca Raffaella, Pirisi Mario, Rondi Valentina, Rosalba Daniela, Vanni Letizia, Vigone Francesca, Navalesi Paolo, Cammarota Gianmaria
Azienda Ospedaliero Universitaria "Maggiore della Carità", Anestesia e Terapia Intensiva, Novara, Italy.
Università del Piemonte Orientale, Dipartimento di Medicina Traslazionale, Novara, Italy.
ERJ Open Res. 2021 Jan 25;7(1). doi: 10.1183/23120541.00541-2020. eCollection 2021 Jan.
We aimed to characterise a large population of coronavirus disease 2019 (COVID-19) patients with moderate-to-severe hypoxaemic acute respiratory failure (ARF) receiving continuous positive airway pressure (CPAP) outside the intensive care unit (ICU), and to ascertain whether the duration of CPAP application increased the risk of mortality for patients requiring intubation.
In this retrospective, multicentre cohort study, we included adult COVID-19 patients, treated with CPAP outside ICU for hypoxaemic ARF from 1 March to 15 April, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay and 60-day in-hospital mortality.
The study included 537 patients with a median (interquartile range (IQR) age of 69 (60-76) years. 391 (73%) were male. According to the pre-defined CPAP therapeutic goal, 397 (74%) patients were included in the full treatment subgroup, and 140 (26%) in the do not intubate (DNI) subgroup. Median (IQR) CPAP duration was 4 (1-8) days, while hospital length of stay was 16 (9-27) days. 60-day in-hospital mortality was 34% (95% CI 0.304-0.384%) overall, and 21% (95% CI 0.169-0.249%) and 73% (95% CI 0.648-0.787%) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95% CI 0.345-0.488%) for 180 (45%) CPAP failures requiring intubation, and 2% (95% CI 0.008-0.035%) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality (hazard ratio 1.093, 95% CI 1.010-1.184).
We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.
我们旨在对大量在重症监护病房（ICU）外接受持续气道正压通气（CPAP）治疗的中度至重度低氧性急性呼吸衰竭（ARF）的2019冠状病毒病（COVID-19）患者进行特征描述，并确定CPAP应用时间延长是否会增加需要插管患者的死亡风险。
在这项回顾性多中心队列研究中，我们纳入了2020年3月1日至4月15日在ICU外接受CPAP治疗低氧性ARF的成年COVID-19患者。我们收集了人口统计学和临床数据，包括CPAP治疗目标、住院时间和60天院内死亡率。
该研究纳入了537例患者，年龄中位数（四分位间距[IQR]）为69（60-76）岁。391例（73%）为男性。根据预先定义的CPAP治疗目标，397例（74%）患者被纳入全治疗亚组，140例（26%）被纳入不插管（DNI）亚组。CPAP持续时间中位数（IQR）为4（1-8）天，住院时间为16（9-27）天。总体60天院内死亡率为34%（95%CI 0.304-0.384%），全治疗亚组和DNI亚组分别为21%（95%CI 0.169-0.249%）和73%（95%CI 0.648-0.787%）。在全治疗亚组中，180例（45%）需要插管的CPAP治疗失败患者的院内死亡率为42%（95%CI 0.345-0.488%），其余217例（55%）成功患者的死亡率为2%（95%CI 0.008-0.035%）。延迟插管与死亡率增加相关（风险比1.093，95%CI 1.010-1.184）。
我们描述了大量在ICU外接受CPAP治疗的COVID-19患者。插管延迟是死亡的一个危险因素。需要进一步研究以早期识别CPAP治疗失败情况。
