tetano
Editor, Senior Moderator
ERJ Open Res
. 2023 Apr 3;9(2):00455-2022.
doi: 10.1183/23120541.00455-2022. eCollection 2023 Mar.
Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study
Alessandra Iacovelli[SUP] 1 2 [/SUP], Maria Luisa Nicolardi[SUP] 1 2 [/SUP], Valentina Baccolini[SUP] 1 [/SUP], Federica Olmati[SUP] 1 2 [/SUP], Ilenia Attilia[SUP] 1 2 [/SUP], Pia Baiocchi[SUP] 1 2 [/SUP], Letizia D'Antoni[SUP] 1 2 [/SUP], Ilaria Menichini[SUP] 1 2 [/SUP], Ambra Migliarini[SUP] 1 2 [/SUP], Daniela Pellegrino[SUP] 1 2 [/SUP], Angelo Petroianni[SUP] 1 2 [/SUP], Daniel Piamonti[SUP] 1 2 [/SUP], Angela Tramontano[SUP] 1 2 [/SUP], Paolo Villari[SUP] 1 [/SUP], Paolo Palange[SUP] 1 2 [/SUP]
Affiliations
Abstract
Background: Respiratory failure is a severe complication in coronavirus disease 2019 (COVID-19) pneumonia that, in addition to oxygen therapy, may require continuous positive airway pressure (CPAP) support. It has been postulated that COVID-19 lung injury may share some features with those observed in hyperoxic acute lung injury. Thus, a correct target arterial oxygen tension (P [SUB]aO[SUB]2[/SUB][/SUB] ) during oxygen supplementation may be crucial to protect the lung from further tissue damage. The aims of this study were: 1) to evaluate the effects of conservative oxygen supplementation during helmet CPAP therapy on mortality and intensive care unit (ICU) admission in patients with COVID-19 and respiratory failure, and 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections.
Methods: This was a single-centre, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or nonconservative oxygen supplementation during helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target P [SUB]aO[SUB]2[/SUB][/SUB] <100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation.
Results: 71 patients were included in the conservative cohort and 75 in the nonconservative cohort. Mortality rate was lower in the conservative cohort (22.5% versus 62.7%; p<0.001). Rates of ICU admission and new-onset organ failure were lower in the conservative cohort (14.1% versus 37.3%; p=0.001 and 9.9% versus 45.3%; p<0.001, respectively).
Conclusions: In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during helmet CPAP was associated with improved survival, lower ICU admission rate and less new-onset organ failure.
. 2023 Apr 3;9(2):00455-2022.
doi: 10.1183/23120541.00455-2022. eCollection 2023 Mar.
Conservative oxygen supplementation during helmet continuous positive airway pressure therapy in patients with COVID-19 and respiratory failure: a pilot study
Alessandra Iacovelli[SUP] 1 2 [/SUP], Maria Luisa Nicolardi[SUP] 1 2 [/SUP], Valentina Baccolini[SUP] 1 [/SUP], Federica Olmati[SUP] 1 2 [/SUP], Ilenia Attilia[SUP] 1 2 [/SUP], Pia Baiocchi[SUP] 1 2 [/SUP], Letizia D'Antoni[SUP] 1 2 [/SUP], Ilaria Menichini[SUP] 1 2 [/SUP], Ambra Migliarini[SUP] 1 2 [/SUP], Daniela Pellegrino[SUP] 1 2 [/SUP], Angelo Petroianni[SUP] 1 2 [/SUP], Daniel Piamonti[SUP] 1 2 [/SUP], Angela Tramontano[SUP] 1 2 [/SUP], Paolo Villari[SUP] 1 [/SUP], Paolo Palange[SUP] 1 2 [/SUP]
Affiliations
- PMID: 37013111
- PMCID: PMC9790093
- DOI: 10.1183/23120541.00455-2022
Abstract
Background: Respiratory failure is a severe complication in coronavirus disease 2019 (COVID-19) pneumonia that, in addition to oxygen therapy, may require continuous positive airway pressure (CPAP) support. It has been postulated that COVID-19 lung injury may share some features with those observed in hyperoxic acute lung injury. Thus, a correct target arterial oxygen tension (P [SUB]aO[SUB]2[/SUB][/SUB] ) during oxygen supplementation may be crucial to protect the lung from further tissue damage. The aims of this study were: 1) to evaluate the effects of conservative oxygen supplementation during helmet CPAP therapy on mortality and intensive care unit (ICU) admission in patients with COVID-19 and respiratory failure, and 2) to evaluate the effect of conservative oxygen supplementation on new-onset organ failure and secondary pulmonary infections.
Methods: This was a single-centre, historically controlled study of patients with severe respiratory failure due to COVID-19 pneumonia, receiving either conservative or nonconservative oxygen supplementation during helmet CPAP. A cohort receiving conservative oxygen supplementation was studied prospectively in which oxygen supplementation was administered with a target P [SUB]aO[SUB]2[/SUB][/SUB] <100 mmHg. Results of this cohort were compared with those of a cohort who had received liberal oxygen supplementation.
Results: 71 patients were included in the conservative cohort and 75 in the nonconservative cohort. Mortality rate was lower in the conservative cohort (22.5% versus 62.7%; p<0.001). Rates of ICU admission and new-onset organ failure were lower in the conservative cohort (14.1% versus 37.3%; p=0.001 and 9.9% versus 45.3%; p<0.001, respectively).
Conclusions: In patients with COVID-19 and severe respiratory failure, conservative oxygen supplementation during helmet CPAP was associated with improved survival, lower ICU admission rate and less new-onset organ failure.