Matos Isabella de Melo, Tomaz Betina Santos, Sales Maria da Penha Uchoa, Gomes Gabriela Carvalho, Viana Junior Antonio Brazil, Gonçalves Miguel R, Holanda Marcelo Alcantara, Pereira Eanes Delgado Barros
. Departamento de Medicina Interna, Universidade Federal do Ceará, Fortaleza (CE) Brasil.
. Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza (CE) Brasil.
J Bras Pneumol. 2024 Dec 6;50(5):e20240299. doi: 10.36416/1806-3756/e20240299. eCollection 2024.
This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation.
This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed.
The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation.
ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.
本研究旨在描述采用头盔接口持续气道正压通气（CPAP）及轻度镇静治疗的新型冠状病毒肺炎（COVID-19）相关急性呼吸窘迫综合征（ARDS）患者的治疗结果，并探索插管和死亡的预测因素。
这是一项回顾性队列研究，纳入了在肺病科病房接受使用巴西研发的头盔（ELMO™）进行CPAP治疗并采用轻度镇静方案的COVID-19相关ARDS患者。分析了患者的人口统计学、临床、影像学和实验室数据，以及ELMO-CPAP治疗的持续时间和反应。
样本包括180例患者。插管避免率为72.8%。无需插管与以下因素呈正相关：年龄较轻、首次治疗中持续使用HELMET-CPAP超过24小时、CT显示肺部受累<75%以及第2小时ROX指数>4.88。总体院内死亡率为18.9%，未插管组和插管组的死亡率分别为3.0%和61.2%。高龄使死亡风险增加2.8倍，插管后增至13倍。
在肺病科病房采用ELMO-CPAP及轻度镇静治疗，超过70%的COVID-19相关中重度ARDS患者治疗成功。年龄较轻、肺部受累情况、ROX指数以及首次头盔CPAP治疗持续时间延长与无需插管相关。高龄和插管与死亡相关。
