Helmet Continuous Positive Airway Pressure in COVID-19 Related Acute Respiratory Distress Syndrome in Respiratory Intermediate Care Unit

Abstract

Background: The SARS-CoV-2 outbreak spread in Lombardy Region (Italy) rapidly saturating intensive care unit beds, forcing the application of noninvasive respiratory support in RICU. Objectives: We aimed to analyze the effects of helmet CPAP in COVID19- related ARDS in RICU. The primary outcome was CPAP failure, defined as the occurrence of either intubation or death due to any cause during RICU stay; the secondary one was the identification of factors related to patients’ prognosis. Methods: 150 consecutive patients with ARDS due to COVID-19 and referred to Vimercate Hospital (MB) between March and May 2020 were enrolled. All patients were treated with helmet CPAP. Demographics, clinical and laboratory tests and blood gas analysis were collected. Results: Patients had a mean (SD) age of 62 (±11) years. The worst PaO2/ FiO2 ratio during continuous positive airway pressure stratified the subjects in mild (26/150), moderate (39/150) and severe (85/150) ARDS. Most of patients were treated with systemic corticosteroids (79%). 93 patients (62%) were successfully treated while 57 (38%) failed; of the latter, 32 patients were transferred in the intensive care unit to receive invasive mechanical ventilation. Dimer test and ferritin at admission, use of steroids, P/F in oxygen at admission and age were independently associated with CPAP failure. The severity of ARDS and the use of steroids strongly correlate with clinical outcomes. Mortality rate in our cohort of patients was 28%. Conclusions: The application of helmet CPAP in RICU and the administration of corticosteroids in COVID19-related ARDS are associated with satisfactory clinical outcomes.