Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia
Feasibility and clinical impact of out-of-ICU noninvasive respiratory support in patients with COVID-19-related pneumonia
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DOI：
10.1183/13993003.02130-2020
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发表时间：
2020-11-01
影响因子：
24.3
通讯作者：
Nava, Stefano
中科院分区：
文献类型：
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作者：
Franco, Cosimo;Facciolongo, Nicola;Nava, Stefano
简介：严重急性呼吸综合征-冠状病毒2型疫情在意大利迅速蔓延，重症监护病房（ICU）床位的缺乏很快变得明显，迫使在ICU外应用无创呼吸支持（NRS），引发了对工作人员污染的担忧。我们的目的是分析医院工作人员的安全性以及NRS应用于ICU外患者的可行性和结局。方法：在这项观察性研究中，分析了2019年3月1日至2020年5月10日期间在9家医院的肺科转诊的670例连续确诊冠状病毒病患者的数据。收集的数据包括药物，模式和使用NRS（即高流量鼻插管（HFNC），持续气道正压通气（CPAP），无创通气（NIV）），住院时间，气管插管（ETI）和deaths.Results：42（11.1%）的医护人员感染检测呈阳性，但其中只有3人需要住院治疗。报告了所有患者（69.3%为男性）的数据，其平均+/- SD年龄为68 +/- 13岁。基线时的动脉血氧分压/吸气氧分数比为152 +/- 79，大多数（49.3%）患者接受CPAP治疗。总体未校正的30天死亡率为26.9%，HFNC、CPAP和NIV分别为16%、30%和30%，而总ETI率为27%，分别为29%、25%和28%;校正混杂因素后，死亡的相对概率与使用的NRS无关。ETI和住院时间在各组之间没有差异。死亡率随着年龄和合并症的进展而增加。结论：ICU外应用NRS是可行的，并与良好的结局相关。然而，这与工作人员受到污染的风险有关。
Introduction: The severe acute respiratory syndrome-coronavirus 2 outbreak spread rapidly in Italy and the lack of intensive care unit (ICU) beds soon became evident, forcing the application of noninvasive respiratory support (NRS) outside the ICU, raising concerns over staff contamination. We aimed to analyse the safety of the hospital staff and the feasibility and outcomes of NRS applied to patients outside the ICU.Methods: In this observational study, data from 670 consecutive patients with confirmed coronavirus disease 2019 referred to pulmonology units in nine hospitals between March 1 and May 10, 2020 were analysed. Data collected included medication, mode and usage of NRS (i.e. high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), noninvasive ventilation (NIV)), length of stay in hospital, endotracheal intubation (ETI) and deaths.Results: 42 (11.1%) healthcare workers tested positive for infection, but only three of them required hospitalisation. Data are reported for all patients (69.3% male), whose mean +/- SD age was 68 +/- 13 years. The arterial oxygen tension/inspiratory oxygen fraction ratio at baseline was 152 +/- 79, and the majority (49.3%) of patients were treated with CPAP. The overall unadjusted 30-day mortality rate was 26.9%, with 16%, 30% and 30% for HFNC, CPAP and NIV, respectively, while the total ETI rate was 27%, with 29%, 25% and 28%, respectively; the relative probability of death was not related to the NRS used after adjustment for confounders. ETI and length of stay were not different among the groups. Mortality rate increased with age and comorbidity class progression.Conclusions: The application of NRS outside the ICU is feasible and associated with favourable outcomes. Nonetheless, it was associated with a risk of staff contamination.