BACKGROUND: Non-invasive mechanical ventilation (NIV) is effective for symptom relief and respiratory support in patients with respiratory insufficiency, severe comorbidities and no indication to intubation. Experience with NIV as the ceiling of treatment in severely compromised novel coronavirus disease (COVID-19) patients is lacking. METHODS: We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment. RESULTS: Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multi-organ insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign haematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h. CONCLUSIONS: NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.
BACKGROUND: Non-invasive mechanical ventilation (NIV) is effective for symptom relief and respiratory support in patients with respiratory insufficiency, severe comorbidities and no indication to intubation. Experience with NIV as the ceiling of treatment in severely compromised novel coronavirus disease (COVID-19) patients is lacking. METHODS: We evaluated 159 patients with COVID-19-related acute respiratory syndrome (ARDS), 38 of whom with NIV as the ceiling of treatment, admitted to an ordinary ward and treated with continuous positive airway pressure (CPAP) and respiratory physiotherapy. Treatment failure and death were correlated with clinical and laboratory parameters in the whole cohort and in patients with NIV as the ceiling of treatment. RESULTS:Patients who had NIV as the ceiling of treatment were elderly, with a low BMI and a high burden of comorbidities, showed clinical and laboratory signs of multi-organ insufficiency on admission and of rapidly deteriorating vital signs during the first week of treatment. NIV failure occurred overall in 77 (48%) patients, and 27/38 patients with NIV as the ceiling of treatment died. Congestive heart failure, chronic benign haematological diseases and inability/refusal to receive respiratory physiotherapy were independently associated to NIV failure and mortality. Need for increased positive end-expiratory pressures and low platelets were associated with NIV failure. Death was associated to cerebrovascular disease, need for CPAP cycles longer than 12h and, in the subgroup of patients with NIV as the ceiling of treatment, was heralded by vital sign deterioration within 48 h. CONCLUSIONS: NIV and physiotherapy are a viable treatment option for patients with severe COVID-19 and severe comorbidities.
Authors: Alberto Zangrillo; Alessandro Belletti; Diego Palumbo; Maria Rosa Calvi; Francesca Guzzo; Evgeny V Fominskiy; Alessandro Ortalda; Pasquale Nardelli; Marco Ripa; Martina Baiardo Redaelli; Giovanni Borghi; Giovanni Landoni; Filippo D'Amico; Marilena Marmiere; Beatrice Righetti; Margherita Rocchi; Marco Saracino; Moreno Tresoldi; Lorenzo Dagna; Francesco De Cobelli Journal: J Cardiothorac Vasc Anesth Date: 2021-11-27 Impact factor: 2.628
Authors: Sarah Damanti; Giuseppe Alvise Ramirez; Enrica Paola Bozzolo; Valentina Da Prat; Giuseppe Di Lucca; Gaetano Di Terlizzi; Alessandro Marinosci; Raffaella Scotti; Silvia Strada; Paolo Scarpellini; Barbara Castiglioni; Chiara Oltolini; Marco Ripa; Chiara Tassan Din; Clarissa Elisabeth Centurioni; Flavia Di Scala; Agnese Gobbi; Ada Carla Alba; Giuseppina Maria Casiraghi; Anna Morgillo; Moreno Tresoldi Journal: Aging Clin Exp Res Date: 2022-03-17 Impact factor: 4.481
Authors: Barbara Bonnesen; Jens-Ulrik Stæhr Jensen; Klaus Nielsen Jeschke; Alexander G Mathioudakis; Alexandru Corlateanu; Ejvind Frausing Hansen; Ulla Møller Weinreich; Ole Hilberg; Pradeesh Sivapalan Journal: Diagnostics (Basel) Date: 2021-12-02