Coppola Silvia, Santus Pierachille, Sotgiu Giovanni, Mondoni Michele, Gandola Alessia, Saad Marina, Sferrazza Papa Giuseppe Francesco, Centanni Stefano, Saderi Laura, Chiumello Davide Alberto, Radovanovic Dejan
Department of Anesthesia and Intensive Care, San Paolo Hospital, ASST Santi Paolo e Carlo, Via di Rudini 8, 20142 Milano, Italy.
Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Via G.B. Grassi 74, 20157 Milano, Italy.
J Clin Med. 2021 Nov 22;10(22):5444. doi: 10.3390/jcm10225444.
The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP failed. Secondary outcomes were in-hospital mortality and in-hospital length of stay (LOS). A retrospective, observational, multicenter study was conducted in intermediate-high dependency respiratory units of two Italian university hospitals. Consecutive patients with COVID-19 treated with CPAP were enrolled. Thoraco-abdominal asynchrony or hemodynamic instability led to ETI. Patients showing SpO ≤ 94%, respiratory rate ≥ 30 bpm or accessory muscle activation on CPAP received NIV. Respiratory distress and desaturation despite NIV eventually led to ETI. 156 patients were included. The overall rate of ETI was 30%, mortality 18% and median LOS 24 (17-32) days. Among patients that failed CPAP ( = 63), 28% were intubated, while the remaining 72% received NIV, of which 65% were intubated. Patients intubated after CPAP showed lower baseline PaO/FiO, lower lymphocyte counts and higher D-dimer values compared with patients intubated after CPAP + NIV. Mortality was 22% with CPAP + ETI, and 20% with CPAP + NIV + ETI. In the case of CPAP failure, a NIV trial appears feasible, does not deteriorate respiratory status and may reduce the need for ETI in COVID-19 patients.
2019冠状病毒病（COVID-19）肺炎患者的最佳无创呼吸策略仍在讨论中。我们旨在评估持续气道正压通气（CPAP）治疗的患者以及CPAP失败后接受无创通气（NIV）患者的气管插管（ETI）率。次要结局为住院死亡率和住院时间（LOS）。在两家意大利大学医院的中高依赖呼吸单元进行了一项回顾性、观察性、多中心研究。纳入连续接受CPAP治疗的COVID-19患者。胸腹部不同步或血流动力学不稳定导致进行ETI。CPAP时SpO₂≤94%、呼吸频率≥30次/分或有辅助肌激活的患者接受NIV。尽管进行了NIV但仍有呼吸窘迫和氧饱和度下降最终导致进行ETI。共纳入156例患者。ETI总发生率为30%，死亡率为18%，中位LOS为24（17 - 32）天。在CPAP失败的患者中（n = 63），28%进行了插管，其余72%接受了NIV，其中65%进行了插管。与CPAP + NIV后插管的患者相比，CPAP后插管的患者基线PaO₂/FiO₂较低、淋巴细胞计数较低且D - 二聚体值较高。CPAP + ETI组的死亡率为22%，CPAP + NIV + ETI组的死亡率为20%。在CPAP失败的情况下，进行NIV试验似乎是可行的，不会使呼吸状况恶化，并且可能减少COVID-19患者对ETI的需求。
