Abstract
BackgroundRespiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).MethodsIn this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients’ data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death.ResultsA total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22–32] to 24 [20–29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3–9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards.ConclusionsHelmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival.Trial Registration: NCT04424992
Highlights
Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support
We present the outcomes associated with treatment of respiratory failure with helmet continuous positive airway pressure (CPAP) during the COVID-19 outbreak in our hospital consortium, an approach which has been widely applied in Northern Italy
We enrolled in the study 306 consecutive patients who failed oxygen mask therapy and underwent helmet CPAP treatment outside the intensive care unit (ICU)
Summary
Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. Coppadoro et al Crit Care (2021) 25:80 respiratory failure presented to hospitals’ emergency rooms, burdening the health system to an unexpected extent. To face such a number of critically ill patients, intensive care beds were more than doubled, with an occupancy close to 100% [1]. One of the effective treatments for respiratory failure, if applied early and in less severe patients, is noninvasive ventilation [2, 3]. Continuous positive airway pressure (CPAP) delivered noninvasively by helmet proved superior to non-rebreathing oxygen mask in community-acquired pneumonia [4, 5]. The optimal treatment of COVID-19 pneumonia is still under debate, and some experts believe that providing a moderate level (< 10 cmH2O) of Positive End-Expiratory Pressure (PEEP) can match patient’s need during the first phase of the disease, albeit this must be balanced with the potential risk of delayed intubation [6,7,8], a topic on which a vigorous debate is ongoing [9]
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