Purpose: To describe the effects of timing of intubation in COVID-19 patients that fail helmet continuous positive airway pressure (h-CPAP) on progression and severity of disease. Methods: COVID-19 patients that failed h-CPAP, required intubation, and underwent chest computed tomography (CT) at two levels of positive end-expiratory pressure (PEEP, 8 and 16 cmH2O) were included in this retrospective study. Patients were divided in two groups (early versus late) based on the duration of h-CPAP before intubation. Endpoints included percentage of non-aerated lung tissue at PEEP of 8 cmH2O, respiratory system compliance and oxygenation. Results: Fifty-two patients were included and classified in early (h-CPAP for ≤2 days, N=26) and late groups (h-CPAP for >2 days, N=26). Patients in the late compared to early intubation group presented: 1) lower respiratory system compliance (median difference, MD -7 mL/cmH2O, p=0.044) and PaO2/FiO2 (MD -29 mmHg, p=0.047), 2) higher percentage of non-aerated lung tissue (MD 7.2%, p=0.023) and 3) similar lung recruitment increasing PEEP from 8 to 16 cmH2O (MD 0.1%, p=0.964). Conclusions: In COVID-19 patients receiving h-CPAP, late intubation was associated with worse clinical presentation at ICU admission and more advanced disease. The possible detrimental effects of delaying intubation should be carefully considered in these patients.

Early versus late intubation in COVID-19 patients failing helmet CPAP: A quantitative computed tomography study

Ball, Lorenzo;Robba, Chiara;Pigati, Maria;Berardino, Andrea;Iannuzzi, Francesca;Battaglini, Denise;Brunetti, Iole;Minetti, Giuseppe;Seitun, Sara;Vena, Antonio;Giacobbe, Daniele Roberto;Bassetti, Matteo;Castellan, Lucio;Patroniti, Nicolò;Pelosi, Paolo
2022

Abstract

Purpose: To describe the effects of timing of intubation in COVID-19 patients that fail helmet continuous positive airway pressure (h-CPAP) on progression and severity of disease. Methods: COVID-19 patients that failed h-CPAP, required intubation, and underwent chest computed tomography (CT) at two levels of positive end-expiratory pressure (PEEP, 8 and 16 cmH2O) were included in this retrospective study. Patients were divided in two groups (early versus late) based on the duration of h-CPAP before intubation. Endpoints included percentage of non-aerated lung tissue at PEEP of 8 cmH2O, respiratory system compliance and oxygenation. Results: Fifty-two patients were included and classified in early (h-CPAP for ≤2 days, N=26) and late groups (h-CPAP for >2 days, N=26). Patients in the late compared to early intubation group presented: 1) lower respiratory system compliance (median difference, MD -7 mL/cmH2O, p=0.044) and PaO2/FiO2 (MD -29 mmHg, p=0.047), 2) higher percentage of non-aerated lung tissue (MD 7.2%, p=0.023) and 3) similar lung recruitment increasing PEEP from 8 to 16 cmH2O (MD 0.1%, p=0.964). Conclusions: In COVID-19 patients receiving h-CPAP, late intubation was associated with worse clinical presentation at ICU admission and more advanced disease. The possible detrimental effects of delaying intubation should be carefully considered in these patients.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11567/1078102
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