Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit

Rosanna Vaschetto, Francesco Barone-Adesi, Fabrizio Racca, Claudio Pissaia, Carlo Maestrone, Davide Colombo, Carlo Olivieri, Nello De Vita, Erminio Santangelo, Lorenza Scotti, Luigi Castello, Tiziana Cena, Martina Taverna, Luca Grillenzoni, Maria Adele Moschella, Gianluca Airoldi, Silvio Borrè, Francesco Mojoli, Francesco Della Corte, Marta Baggiani, Sara Baino, Piero Balbo, Simona Bazzano, Valeria Bonato, Sara Carbonati, Federico Crimaldi, Veronica Daffara, Luca De Col, Matteo Maestrone, Mario Malerba, Federica Moroni, Raffaella Perucca, Mario Pirisi, Valentina Rondi, Daniela Rosalba, Letizia Vanni, Francesca Vigone, Paolo Navalesi, Gianmaria Cammarota, Rosanna Vaschetto, Francesco Barone-Adesi, Fabrizio Racca, Claudio Pissaia, Carlo Maestrone, Davide Colombo, Carlo Olivieri, Nello De Vita, Erminio Santangelo, Lorenza Scotti, Luigi Castello, Tiziana Cena, Martina Taverna, Luca Grillenzoni, Maria Adele Moschella, Gianluca Airoldi, Silvio Borrè, Francesco Mojoli, Francesco Della Corte, Marta Baggiani, Sara Baino, Piero Balbo, Simona Bazzano, Valeria Bonato, Sara Carbonati, Federico Crimaldi, Veronica Daffara, Luca De Col, Matteo Maestrone, Mario Malerba, Federica Moroni, Raffaella Perucca, Mario Pirisi, Valentina Rondi, Daniela Rosalba, Letizia Vanni, Francesca Vigone, Paolo Navalesi, Gianmaria Cammarota

Abstract

Aim: We aimed to characterise a large population of coronavirus disease 2019 (COVID-19) patients with moderate-to-severe hypoxaemic acute respiratory failure (ARF) receiving continuous positive airway pressure (CPAP) outside the intensive care unit (ICU), and to ascertain whether the duration of CPAP application increased the risk of mortality for patients requiring intubation.

Methods: In this retrospective, multicentre cohort study, we included adult COVID-19 patients, treated with CPAP outside ICU for hypoxaemic ARF from 1 March to 15 April, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay and 60-day in-hospital mortality.

Results: The study included 537 patients with a median (interquartile range (IQR) age of 69 (60-76) years. 391 (73%) were male. According to the pre-defined CPAP therapeutic goal, 397 (74%) patients were included in the full treatment subgroup, and 140 (26%) in the do not intubate (DNI) subgroup. Median (IQR) CPAP duration was 4 (1-8) days, while hospital length of stay was 16 (9-27) days. 60-day in-hospital mortality was 34% (95% CI 0.304-0.384%) overall, and 21% (95% CI 0.169-0.249%) and 73% (95% CI 0.648-0.787%) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95% CI 0.345-0.488%) for 180 (45%) CPAP failures requiring intubation, and 2% (95% CI 0.008-0.035%) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality (hazard ratio 1.093, 95% CI 1.010-1.184).

Conclusions: We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.

Conflict of interest statement

Conflict of interest: R. Vaschetto has nothing to disclose. Conflict of interest: F. Barone-Adesi has nothing to disclose. Conflict of interest: F. Racca reports personal fees from Philips Respironics outside the submitted work. Conflict of interest: C. Pissaia has nothing to disclose. Conflict of interest: C. Maestrone has nothing to disclose. Conflict of interest: D. Colombo reports personal fees for lectures from Nestlé Healthcare Nutrition outside the submitted work. Conflict of interest: C. Olivieri has a patent 102016000114357 with royalties paid to Intersurgical SpA. Conflict of interest: N. De Vita has nothing to disclose. Conflict of interest: E. Santangelo has nothing to disclose. Conflict of interest: L. Scotti has nothing to disclose. Conflict of interest: L. Castello has nothing to disclose. Conflict of interest: T. Cena has nothing to disclose. Conflict of interest: M. Taverna has nothing to disclose. Conflict of interest: L. Grillenzoni has nothing to disclose. Conflict of interest: M.A. Moschella has nothing to disclose. Conflict of interest: G. Airoldi has nothing to disclose. Conflict of interest: S. Borrè has nothing to disclose. Conflict of interest: F. Mojoli reports personal fees for lecturing from GE Healthcare, Medical and Seda Spa, outside the submitted work; and a consultancy agreement between University of Pavia and Hamilton Medical. Conflict of interest: F. Della Corte has nothing to disclose. Conflict of interest: M. Baggiani has nothing to disclose. Conflict of interest: S. Baino has nothing to disclose. Conflict of interest: P. Balbo has nothing to disclose. Conflict of interest: S. Bazzano has nothing to disclose. Conflict of interest: V. Bonato has nothing to disclose. Conflict of interest: S. Carbonati has nothing to disclose. Conflict of interest: F. Crimaldi has nothing to disclose. Conflict of interest: V. Daffara has nothing to disclose. Conflict of interest: L. De Col has nothing to disclose. Conflict of interest: M. Maestrone has nothing to disclose. Conflict of interest: M. Malerba has nothing to disclose. Conflict of interest: F. Moroni has nothing to disclose. Conflict of interest: R. Perucca has nothing to disclose. Conflict of interest: M. Pirisi has nothing to disclose. Conflict of interest: V. Rondi has nothing to disclose. Conflict of interest: D. Rosalba has nothing to disclose. Conflict of interest: L. Vanni has nothing to disclose. Conflict of interest: F. Vigone has nothing to disclose. Conflict of interest: P. Navalesi reports personal fees from Intersurgical SpA, Resmed, Philips, Novartis, MSD, Getinge and Orion Pharma, and research equipment (institutional) from Draeger, outside the submitted work; in addition, he has a patent 102020000008305 pending to Università di Padova (no profit) and a patent 102016000114357 with royalties paid to Intersurgical SpA. Conflict of interest: G. Cammarota has nothing to disclose.

Copyright ©ERS 2021.

Figures

FIGURE 1
FIGURE 1
Cumulative incidence of in-hospital mortality in a) all patients and b) stratified by treatment, i.e. do not intubate (DNI) and full treatment. Data are presented with 95% CI. CPAP: noninvasive continuous positive airway pressure.
FIGURE 2
FIGURE 2
Cumulative incidence of in-hospital mortality in patients requiring invasive mechanical ventilation. Data are presented with 95% CI. ETI: endotracheal intubation.

References

    1. Rochwerg B, Brochard L, Elliott MW, et al. . Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50: 1602426. doi:10.1183/13993003.02426-2016
    1. Masip J, Roque M, Sánchez B, et al. . Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 2005; 294: 3124–3130. doi:10.1001/jama.294.24.3124
    1. Lemiale V, Mokart D, Resche-Rigon M, et al. . Effect of noninvasive ventilation vs oxygen therapy on mortality among immunocompromised patients with acute respiratory failure: a randomized clinical trial. JAMA 2015; 314: 1711–1719. doi:10.1001/jama.2015.12402
    1. Jaber S, Lescot T, Futier E, et al. . Effect of noninvasive ventilation on tracheal reintubation among patients with hypoxemic respiratory failure following abdominal surgery: a randomized clinical trial. JAMA 2016; 315: 1345–1353. doi:10.1001/jama.2016.2706
    1. Namendys-Silva SA, Hernández-Garay M, Rivero-Sigarroa E. Non-invasive ventilation for critically ill patients with pandemic H1N1 2009 influenza A virus infection. Crit Care 2010; 14: 407. doi:10.1186/cc8883
    1. Curtis JR, Cook DJ, Sinuff T, et al. . Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med 2007; 35: 932–939. doi:10.1097/01.CCM.0000256725.73993.74
    1. Cabrini L, Moizo E, Nicelli E, et al. . Noninvasive ventilation outside the intensive care unit from the patient point of view: a pilot study. Respir Care 2012; 57: 704–709.
    1. Cabrini L, Esquinas A, Pasin L, et al. . An international survey on noninvasive ventilation use for acute respiratory failure in general non-monitored wards. Respir Care 2015; 60: 586–592. doi:10.4187/respcare.03593
    1. Arentz M, Yim E, Klaff L, et al. . Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020; 323: 1612–1614. doi:10.1001/jama.2020.4326
    1. Grasselli G, Zangrillo A, Zanella A, et al. . Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy region, Italy. JAMA 2020; 323: 1574–1581. doi:10.1001/jama.2020.5394
    1. Yang X, Yu Y, Xu J, et al. . Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475–481. doi:10.1016/S2213-2600(20)30079-5
    1. Richardson S, Hirsch JS, Narasimhan M, et al. . Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323: 2052–2059. doi:10.1001/jama.2020.6775
    1. Wang D, Hu B, Hu C, et al. . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061–1069. doi:10.1001/jama.2020.1585
    1. Oranger M, Gonzalez-Bermejo J, Dacosta-Noble P, et al. . Continuous positive airway pressure to avoid intubation in SARS-CoV-2 pneumonia: a two-period retrospective case–control study. Eur Respir J 2020; 56: 2001692. doi:10.1183/13993003.01692-2020
    1. Huang C, Wang Y, Li X, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. doi:10.1016/S0140-6736(20)30183-5
    1. Gristina GR, Orsi L, Carlucci A, et al. . Parte I. Il percorso clinico e assistenziale nelle insufficienze croniche d'organo “end-stage”. Documento di consenso per una pianificazione condivisa delle scelte di cura. [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway]. Recenti Prog Med 2014; 105: 9–24.
    1. Charlson ME, Pompei P, Ales KL, et al. . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383. doi:10.1016/0021-9681(87)90171-8
    1. Resche-Rigon M, Azoulay E, Chevret S. Evaluating mortality in intensive care units: contribution of competing risks analyses. Crit Care 2006; 10: R5. doi:10.1186/cc3921
    1. Guan WJ, Ni ZY, Hu Y, et al. . Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–1720. doi:10.1056/NEJMoa2002032
    1. Brambilla AM, Prina E, Ferrari G, et al. . Non-invasive positive pressure ventilation in pneumonia outside intensive care unit: an Italian multicenter observational study. Eur J Intern Med 2019; 59: 21–26. doi:10.1016/j.ejim.2018.09.025
    1. Frat JP, Thille AW, Mercat A, et al. . High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372: 2185–2196. doi:10.1056/NEJMoa1503326
    1. Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med 2017; 195: 438–442. doi:10.1164/rccm.201605-1081CP
    1. Brochard L, Lefebvre JC, Cordioli RL, et al. . Noninvasive ventilation for patients with hypoxemic acute respiratory failure. Semin Respir Crit Care Med 2014; 35: 492–500. doi:10.1055/s-0034-1383863
    1. Esquinas AM, Egbert Pravinkumar S, Scala R, et al. . Noninvasive mechanical ventilation in high-risk pulmonary infections: a clinical review. Eur Respir Rev 2014; 23: 427–438. doi:10.1183/09059180.00009413
    1. Alraddadi BM, Qushmaq I, Al-Hameed FM, et al. . Noninvasive ventilation in critically ill patients with the Middle East respiratory syndrome. Influenza Other Respir Viruses 2019; 13: 382–390. doi:10.1111/irv.12635
    1. Esteban A, Frutos-Vivar F, Muriel A, et al. . Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188: 220–230. doi:10.1164/rccm.201212-2169OC
    1. Vargas F, Thille A, Lyazidi A, et al. . Helmet with specific settings versus facemask for noninvasive ventilation. Crit Care Med 2009; 37: 1921–1928. doi:10.1097/CCM.0b013e31819fff93

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться