Predictors of intubation in COVID-19 patients treated with noninvasive continuous positive airway pressure in Intensive Care Medicine Experimental
2020
AOU Città della Salute di Torino
ASL VCO
AOU Alessandria
ASL Biella
ASL Novara
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (13)Vedi tutti...
Vaschetto R
Department of Human Pathology of Adult and Childhood Gaetano Barresi, Unit of Pediatric Surgery, University of Messina, Messina, Italy
Cammarota G
Department of Human Pathology of Adult and Childhood Gaetano Barresi, Unit of Pediatric Surgery, University of Messina, Messina, Italy
Della Corte F
Department of Human Pathology of Adult and Childhood Gaetano Barresi, Unit of Pediatric Surgery, University of Messina, Messina, Italy
et alii...
Abstract
Introduction: Despite some new evidence, the use of noninvasive continuous positive airway pressure (nCPAP) during coronavirus disease 2019 (COVID-19) is still an issue. In a large population of COVID- 19 patients treated with nCPAP we aimed to identify early factors associated with intubation. Methods: Post hoc analysis of an observational prospective-retrospective multicentre study performed in six Italian hospitals. We included in this analysis all patients treated with nCPAP outside ICU due to COVID-19 and candidate to intubation in case of nCPAP failure. We collected demographic and clinical data at hospital entrance and PaO2/ FiO2 percentage increase between Venturi mask ( PaO2/FiO- 2VENT) and nCPAP ( PaO2/FiO2nCPAP) i.e., ?PaO2/FiO2, calculated as ( PaO2/FiO2nCPAP - PaO2/ FiO2VENT)/ PaO2/ FiO2VENT x 100. Results: From March 1st to April 15th, a total of 397 patients with confirmed COVID-19 were treated with nCPAP with a full treatment therapeutic goal. Of these, 8% of the patients were excluded from the analysis as intubated on the same day nCPAP was started. Univariate analysis showed that among the demographic and clinical patients' characteristics, age (65 (IQR, 55-71) vs. 68 (IQR 58-73) years), lactate dehydrogenase (LDH) (518 (IQR, 360-676) U/L vs. 654 (IQR, 486-922) U/L), white blood cells (6.75(IQR, 5.11-8.91) × 103/?L vs. 7.04 (IQR, 5.17-10.00) × 103/?L) resulted significantly lower in patients succeeding nCPAP compared to those who failed nCPAP and were intubated. Percentage increase in PaO2/ FiO2 (87(IQR, 7-203) vs. 44(IQR,12-120)) was higher in patients who succeeded nCPAP compared to those who failed. Male gender was also significantly associated with intubation. A multivariate analysis adjusting for age, gender, Charlson comorbidity index, percentage increase in PaO2/ FiO2, lactate, white blood cell count, LDH and C-reactive protein levels led to an area under the curve of 0.77 and confirmed that age (relative risk, 1.023; 95% CI, 1.0
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DOI : 10.1186/s40635-020-00354-8
Keywords
Venturi mask; univariate analysis; treatment failure; risk factor; retrospective study; respiratory failure; protein expression; prospective study; post hoc analysis; multicenter study; male; major clinical study; leukocyte count; intubation; human cell; gene expression; human; gender; demography; female; coronavirus disease 2019; controlled study; continuous positive airway pressure; conference abstract; Charlson Comorbidity Index; area under the curve; adult; lactic acid; lactate dehydrogenase; endogenous compound; C reactive protein;