Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study.
Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study.
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DOI：
10.1371/journal.pone.0240645
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Ioos V
中科院分区：
文献类型：
--
作者：
Alviset S;Riller Q;Aboab J;Dilworth K;Billy PA;Lombardi Y;Azzi M;Ferreira Vargas L;Laine L;Lermuzeaux M;Mémain N;Silva D;Tchoubou T;Ushmorova D;Dabbagh H;Escoda S;Lefrançois R;Nardi A;Ngima A;Ioos V
由于COVID-19大流行，重症监护病房（ICU）可能会因低氧血症患者的数量而不堪重负。这项单中心回顾性观察性队列研究在一家法国医院进行，尽管床位从18张增加到32张，但患者数量超过了ICU的容量。因此，159名需要ICU护理的患者中有59名（37%）被转介到其他医院。从3月27日至4月23日，连续发生呼吸衰竭或无法维持SpO 2> 90%的患者，尽管使用非再呼吸器面罩接受了10-15 l/min的氧气，但仍接受了持续气道正压通气（CPAP）治疗，除非ICU医生判断需要立即插管。我们描述了这些患者的特征，临床过程和结果。研究的主要结局是CPAP停药。49例患者开始CPAP，41例（84%）在ICU外进行。中位年龄为65岁（IQR = 54-71），36例（73%）为男性。在10 - 15 L/min氧流量下，CPAP前的中位呼吸频率为36（30-40），中位SpO 2为92%（90-95）。CPAP的中位持续时间为3天（IQR = 1-5）。停用CPAP的原因为：25例（51%）插管，16例（33%）改善，6例（12%）耐受不良，2例（4%）死亡。8名患者决定不插管，包括2名在CPAP期间死亡的患者。2例患者因耐受性差接受了不到1小时的CPAP治疗。最后，39例可评价患者中有15例（38%）仅使用CPAP恢复，而24例（62%）进行了插管。在大量患者涌入的情况下，CPAP在非ICU环境中可行。在我们的队列中，高达1/3的急性呼吸衰竭患者在未插管的情况下恢复。
Because of the COVID-19 pandemic, intensive care units (ICU) can be overwhelmed by the number of hypoxemic patients. This single centre retrospective observational cohort study took place in a French hospital where the number of patients exceeded the ICU capacity despite an increase from 18 to 32 beds. Because of this, 59 (37%) of the 159 patients requiring ICU care were referred to other hospitals. From 27th March to 23rd April, consecutive patients who had respiratory failure or were unable to maintain an SpO2 > 90%, despite receiving 10–15 l/min of oxygen with a non-rebreather mask, were treated by continuous positive airway pressure (CPAP) unless the ICU physician judged that immediate intubation was indicated. We describe the characteristics, clinical course, and outcomes of these patients. The main outcome under study was CPAP discontinuation. CPAP was initiated in 49 patients and performed out of ICU in 41 (84%). Median age was 65 years (IQR = 54–71) and 36 (73%) were men. Median respiratory rate before CPAP was 36 (30–40) and median SpO2 was 92% (90–95) under 10 to 15 L/min oxygen flow. Median duration of CPAP was 3 days (IQR = 1–5). Reasons for discontinuation of CPAP were: intubation in 25 (51%), improvement in 16 (33%), poor tolerance in 6 (12%) and death in 2 (4%) patients. A decision not to intubate had been taken for 8 patients, including the 2 who died while on CPAP. Two patients underwent less than one hour CPAP for poor tolerance. In the end, 15 (38%) out of 39 evaluable patients recovered with only CPAP whereas 24 (62%) were intubated. CPAP is feasible in a non-ICU environment in the context of massive influx of patients. In our cohort up to 1/3 of the patients presenting with acute respiratory failure recovered without intubation.
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影响因子：
158.5
作者：
BERSTEN, AD;HOLT, AW;BAGGOLEY, CJ
通讯作者：
BAGGOLEY, CJ
影响因子：
9.6
作者：
Hui, David S.;Chow, Benny K.;Chan, Matthew T. V.
通讯作者：
Chan, Matthew T. V.
影响因子：
120.7
作者：
Delclaux, C;L'Her, E;Brochard, L
通讯作者：
Brochard, L
DOI：
10.1164/rccm.201605-1081cp
发表时间：
2017-02-15
影响因子：
24.7
作者：
Brochard, Laurent;Slutsky, Arthur;Pesenti, Antonio
通讯作者：
Pesenti, Antonio
影响因子：
105.7
作者：
Docherty, Annemarie B.;Harrison, Ewen M.;Semple, Malcolm G.
通讯作者：
Semple, Malcolm G.