Brusasco Claudia, Corradi Francesco, Dazzi Federico, Isirdi Alessandro, Romei Chiara, Parisini Andrea, Boni Silvia, Santori Gregorio, Brusasco Vito
Anesthesia and Intensive Care Unit, E.O. Ospedali Galliera, Genoa, Italy.
Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
ERJ Open Res. 2023 Mar 6;9(2). doi: 10.1183/23120541.00365-2022. eCollection 2023 Mar.
In a preliminary study during the first COVID-19 pandemic wave, we reported a high rate of success with continuous positive airway pressure (CPAP) in preventing death and invasive mechanical ventilation (IMV). That study, however, was too small to identify risk factors for mortality, barotrauma and impact on subsequent IMV. Thus, we re-evaluated the efficacy of the same CPAP protocol in a larger series of patients during second and third pandemic waves.
281 COVID-19 patients with moderate-to-severe acute hypoxaemic respiratory failure (158 full-code and 123 do-not-intubate (DNI)), were managed with high-flow CPAP early in their hospitalisation. IMV was considered after 4 days of unsuccessful CPAP.
The overall recovery rate from respiratory failure was 50% in the DNI and 89% in the full-code group. Among the latter, 71% recovered with CPAP-only, 3% died under CPAP and 26% were intubated after a median CPAP time of 7 days (IQR: 5-12 days). Of the patients who were intubated, 68% recovered and were discharged from the hospital within 28 days. Barotrauma occurred during CPAP in <4% of patients. Age (OR 1.128; p <0.001) and tomographic severity score (OR 1.139; p=0.006) were the only independent predictors of mortality.
Early treatment with CPAP is a safe option for patients with acute hypoxaemic respiratory failure due to COVID-19.
在新冠疫情第一波期间的一项初步研究中，我们报告了持续气道正压通气（CPAP）在预防死亡和有创机械通气（IMV）方面的高成功率。然而，该研究规模太小，无法确定死亡率、气压伤的危险因素以及对后续IMV的影响。因此，我们在疫情第二波和第三波期间，对更多患者重新评估了相同CPAP方案的疗效。
281例中度至重度急性低氧性呼吸衰竭的新冠患者（158例为全力抢救患者，123例为不插管（DNI）患者）在住院早期接受了高流量CPAP治疗。CPAP治疗4天无效后考虑进行IMV。
DNI组呼吸衰竭的总体恢复率为50%，全力抢救组为89%。在后者中，71%仅通过CPAP恢复，3%在CPAP治疗期间死亡，26%在CPAP治疗中位时间7天（四分位间距：5 - 12天）后插管。在插管患者中，68%恢复并在28天内出院。CPAP治疗期间气压伤发生率<4%。年龄（比值比1.128；p<0.001）和断层扫描严重程度评分（比值比1.139；p = 0.006）是仅有的死亡率独立预测因素。
对于新冠所致急性低氧性呼吸衰竭患者，早期使用CPAP治疗是一种安全的选择。
