Journal
MINERVA MEDICA
Volume 113, Issue 2, Pages 281-290Publisher
EDIZIONI MINERVA MEDICA
DOI: 10.23736/S0026-4806.20.06952-9
Keywords
COVID-19; Respiratory distress syndrome; Continuous positive airway pressure; Noninvasive ventilation; Pronation
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This study examined the efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the Intensive Care Unit for COVID-19 patients. The results showed that continuous positive airway pressure with patient mobilization, including pronation, was effective and safe for managing COVID-19-related acute respiratory distress syndrome outside the Intensive Care Unit.
BACKGROUND: The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the Intensive Care Unit during a pandemic. METHODS: In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure =10 cm H2O, FiO(2)=0.6, daily treatment duration: 4 x3h-cycles) and respiratory physiotherapy including pronation outside the Intensive Care Unit were followed-up. RESULTS: Of 90 acute respiratory distress syndrome (ARDS) patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the Intensive Care Unit and with a median (interquartile) follow-up of 37 (1146) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (P=0.033). No safety issues were observed. CONCLUSIONS: Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the Intensive Care Unit setting during the pandemic.
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