Isabella de Melo Matos, Betina Santos Tomaz, Maria da Penha Uchoa Sales, Gabriela Carvalho Gomes, Antonio Brazil Viana Junior, Miguel R Gonçalves, Marcelo Alcantara Holanda, Eanes Delgado Barros Pereira
{"title":"中度至重度ARDS轻度镇静患者通过头盔接口进行CPAP: ICU外成功的预测因素","authors":"Isabella de Melo Matos, Betina Santos Tomaz, Maria da Penha Uchoa Sales, Gabriela Carvalho Gomes, Antonio Brazil Viana Junior, Miguel R Gonçalves, Marcelo Alcantara Holanda, Eanes Delgado Barros Pereira","doi":"10.36416/1806-3756/e20240299","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation.</p><p><strong>Methods: </strong>This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed.</p><p><strong>Results: </strong>The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation.</p><p><strong>Conclusions: </strong>ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.</p>","PeriodicalId":14845,"journal":{"name":"Jornal Brasileiro De Pneumologia","volume":"50 5","pages":"e20240299"},"PeriodicalIF":2.9000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11601069/pdf/","citationCount":"0","resultStr":"{\"title\":\"CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU.\",\"authors\":\"Isabella de Melo Matos, Betina Santos Tomaz, Maria da Penha Uchoa Sales, Gabriela Carvalho Gomes, Antonio Brazil Viana Junior, Miguel R Gonçalves, Marcelo Alcantara Holanda, Eanes Delgado Barros Pereira\",\"doi\":\"10.36416/1806-3756/e20240299\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation.</p><p><strong>Methods: </strong>This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed.</p><p><strong>Results: </strong>The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation.</p><p><strong>Conclusions: </strong>ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.</p>\",\"PeriodicalId\":14845,\"journal\":{\"name\":\"Jornal Brasileiro De Pneumologia\",\"volume\":\"50 5\",\"pages\":\"e20240299\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2024-12-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11601069/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Jornal Brasileiro De Pneumologia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.36416/1806-3756/e20240299\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Jornal Brasileiro De Pneumologia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.36416/1806-3756/e20240299","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU.
Objective: This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation.
Methods: This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed.
Results: The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation.
Conclusions: ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.
期刊介绍:
The Brazilian Journal of Pulmonology publishes scientific articles that contribute to the improvement of knowledge in the field of the lung diseases and related areas.