Early versus late intubation in COVID-19 patients failing helmet CPAP: A quantitative computed tomography study.
Early versus late intubation in COVID-19 patients failing helmet CPAP: A quantitative computed tomography study.
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DOI：
10.1016/j.resp.2022.103889
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发表时间：
2022-07
影响因子：
2.3
通讯作者：
GECOVID Group
中科院分区：
文献类型：
--
作者：
Ball L;Robba C;Herrmann J;Gerard SE;Xin Y;Pigati M;Berardino A;Iannuzzi F;Battaglini D;Brunetti I;Minetti G;Seitun S;Vena A;Giacobbe DR;Bassetti M;Rocco PRM;Cereda M;Castellan L;Patroniti N;Pelosi P;GECOVID Group
目的探讨头盔持续气道正压通气（h-CPAP）失败的COVID-19患者插管时机对疾病进展和严重程度的影响。本回顾性研究纳入了h-CPAP失败、需要插管并在两个呼气末正压水平（PEEP， 8和16 cmH2O）下进行胸部计算机断层扫描（CT）的COVID-19患者。根据插管前h-CPAP持续时间将患者分为两组（早期和晚期）。终点包括8 cmH2O PEEP时未通气肺组织百分比、呼吸系统顺应性和氧合。纳入52例患者，分为早期组（h-CPAP≤2天，N = 26）和晚期组（h-CPAP≤2天，N = 26）。与早期插管组相比，晚期插管组患者表现为：1)呼吸系统顺应性较低（中位差，MD−7 mL/cmH2O, p = 0.044）， PaO2/FiO2 （MD−29 mmHg, p = 0.047), 2)非通气肺组织比例较高（MD为7.2%,p = 0.023）， 3）肺复吸相似，PEEP从8 cmH2O增加至16 cmH2O （MD为0.1%,p = 0.964）。在接受h-CPAP的COVID-19患者中，晚期插管与ICU入院时的临床表现更差和疾病更晚期相关。延迟插管可能产生的不利影响应仔细考虑在这些患者。
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. 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. 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). 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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影响因子：
8.1
作者：
Coppola S;Pozzi T;Gurgitano M;Liguori A;Duka E;Bichi F;Ciabattoni A;Chiumello D
通讯作者：
Chiumello D
影响因子：
8.8
作者：
KATZ, JA;OZANNE, GM;FAIRLEY, HB
通讯作者：
FAIRLEY, HB
影响因子：
24.3
作者：
Franco, Cosimo;Facciolongo, Nicola;Nava, Stefano
通讯作者：
Nava, Stefano
影响因子：
10.9
作者：
Gerard, Sarah E.;Herrmann, Jacob;Reinhardt, Joseph M.
通讯作者：
Reinhardt, Joseph M.
影响因子：
3.5
作者：
Protti A;Iapichino GE;Milesi M;Melis V;Pugni P;Comini B;Cressoni M;Gattinoni L
通讯作者：
Gattinoni L