Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study
Background. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Canadian Respiratory Journal |
| Online Access: | http://dx.doi.org/10.1155/2022/1499690 |
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| author | Pierachille Santus Stefano Pini Francesco Amati Marina Saad Marina Gatti Michele Mondoni Francesco Tursi Maurizio Rizzi Davide Alberto Chiumello Valter Monzani Francesco Blasi Stefano Aliberti Dejan Radovanovic |
| author_facet | Pierachille Santus Stefano Pini Francesco Amati Marina Saad Marina Gatti Michele Mondoni Francesco Tursi Maurizio Rizzi Davide Alberto Chiumello Valter Monzani Francesco Blasi Stefano Aliberti Dejan Radovanovic |
| author_sort | Pierachille Santus |
| collection | DOAJ |
| description | Background. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory indexes as possible predictors of CPAP failure in ARF due to COVID-19. Methods. This was a multicenter, prospective, observational, and cohort study conducted in the respiratory units of three University hospitals in Milan and in a secondary care hospital in Codogno (Italy), on consecutive adult patients with ARF due to COVID-19 pneumonia that underwent CPAP between March 2020 and March 2021. ETI transfer to the intensive care unit or death is defined CPAP failure. Predictors of CPAP failure were assessed before T0 and 1 hour after T1 CPAP initiation and included mROX index (ratio of PaO2/FiO2 to respiratory rate), alveolar-to-arterial (A-a) O2 gradient, and the HACOR (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) score. Results. Three hundred and fifty four patients (mean age 64 years, 73% males) were included in the study; 136 (38.4%) satisfied criteria for CPAP failure. A-a O2 gradient, mROX, and HACOR scores were worse in patients who failed CPAP, both at T0 and T1 (p<0.001 for all parameters). The HACOR score was associated with CPAP failure (odds ratio—OR—for every unit increase in HACOR = 1.361; 95%CI: 1.103–1.680; p=0.004; AUROC = 0.742; p<0.001). CPAP failure was best predicted by a threshold of 4.50 (sensitivity = 53% and specificity = 87%). Conclusions. The HACOR score may be a reliable and early predictor of CPAP failure in patients treated for ARF in COVID-19 pneumonia. |
| format | Article |
| id | doaj-art-9d4ea33a80774877bc2dd2d5021454ad |
| institution | OA Journals |
| issn | 1916-7245 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
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| series | Canadian Respiratory Journal |
| spelling | doaj-art-9d4ea33a80774877bc2dd2d5021454ad2025-08-20T02:20:19ZengWileyCanadian Respiratory Journal1916-72452022-01-01202210.1155/2022/1499690Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort StudyPierachille Santus0Stefano Pini1Francesco Amati2Marina Saad3Marina Gatti4Michele Mondoni5Francesco Tursi6Maurizio Rizzi7Davide Alberto Chiumello8Valter Monzani9Francesco Blasi10Stefano Aliberti11Dejan Radovanovic12Division of Respiratory DiseasesDivision of Respiratory DiseasesRespiratory UnitDivision of Respiratory DiseasesDivision of Respiratory DiseasesRespiratory UnitUOS PneumologiaDivision of Respiratory DiseasesDipartimento di Scienze Della SaluteFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoDepartment of Biomedical SciencesDivision of Respiratory DiseasesBackground. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory indexes as possible predictors of CPAP failure in ARF due to COVID-19. Methods. This was a multicenter, prospective, observational, and cohort study conducted in the respiratory units of three University hospitals in Milan and in a secondary care hospital in Codogno (Italy), on consecutive adult patients with ARF due to COVID-19 pneumonia that underwent CPAP between March 2020 and March 2021. ETI transfer to the intensive care unit or death is defined CPAP failure. Predictors of CPAP failure were assessed before T0 and 1 hour after T1 CPAP initiation and included mROX index (ratio of PaO2/FiO2 to respiratory rate), alveolar-to-arterial (A-a) O2 gradient, and the HACOR (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) score. Results. Three hundred and fifty four patients (mean age 64 years, 73% males) were included in the study; 136 (38.4%) satisfied criteria for CPAP failure. A-a O2 gradient, mROX, and HACOR scores were worse in patients who failed CPAP, both at T0 and T1 (p<0.001 for all parameters). The HACOR score was associated with CPAP failure (odds ratio—OR—for every unit increase in HACOR = 1.361; 95%CI: 1.103–1.680; p=0.004; AUROC = 0.742; p<0.001). CPAP failure was best predicted by a threshold of 4.50 (sensitivity = 53% and specificity = 87%). Conclusions. The HACOR score may be a reliable and early predictor of CPAP failure in patients treated for ARF in COVID-19 pneumonia.http://dx.doi.org/10.1155/2022/1499690 |
| spellingShingle | Pierachille Santus Stefano Pini Francesco Amati Marina Saad Marina Gatti Michele Mondoni Francesco Tursi Maurizio Rizzi Davide Alberto Chiumello Valter Monzani Francesco Blasi Stefano Aliberti Dejan Radovanovic Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study Canadian Respiratory Journal |
| title | Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study |
| title_full | Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study |
| title_fullStr | Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study |
| title_full_unstemmed | Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study |
| title_short | Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study |
| title_sort | predictors of helmet cpap failure in covid 19 pneumonia a prospective multicenter and observational cohort study |
| url | http://dx.doi.org/10.1155/2022/1499690 |
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