Journal article
Early versus late intubation in COVID-19 patients failing helmet CPAP: A quantitative computed tomography study
Respiratory physiology & neurobiology, Vol.301, pp.103889-103889
07/2022
DOI: 10.1016/j.resp.2022.103889
PMCID: PMC8928743
PMID: 35307564
Abstract
To describe the effects of timing of intubation in COVID-19 patients that fail helmet continuous positive airway pressure (h-CPAP) on progression and severity of disease.
COVID-19 patients that failed h-CPAP, required intubation, and underwent chest computed tomography (CT) at two levels of positive end-expiratory pressure (PEEP, 8 and 16 cmH2O) were included in this retrospective study. Patients were divided in two groups (early versus late) based on the duration of h-CPAP before intubation. Endpoints included percentage of non-aerated lung tissue at PEEP of 8 cmH2O, respiratory system compliance and oxygenation.
Fifty-two patients were included and classified in early (h-CPAP for ≤2 days, N = 26) and late groups (h-CPAP for >2 days, N = 26). Patients in the late compared to early intubation group presented: 1) lower respiratory system compliance (median difference, MD −7 mL/cmH2O, p = 0.044) and PaO2/FiO2 (MD −29 mmHg, p = 0.047), 2) higher percentage of non-aerated lung tissue (MD 7.2%, p = 0.023) and 3) similar lung recruitment increasing PEEP from 8 to 16 cmH2O (MD 0.1%, p = 0.964).
In COVID-19 patients receiving h-CPAP, late intubation was associated with worse clinical presentation at ICU admission and more advanced disease. The possible detrimental effects of delaying intubation should be carefully considered in these patients.
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•In COVID-19 patients, late versus early intubation was associated with more non-aerated and poorly-aerated lung tissue.•Patients receiving late versus early intubation had worse oxygenation and respiratory system compliance at intubation and intensive care unit (ICU) admission.•Patients receiving late versus early intubation have similar potential for lung recruitment increasing PEEP from 8 to 16 cmH2O.
Details
- Title: Subtitle
- Early versus late intubation in COVID-19 patients failing helmet CPAP: A quantitative computed tomography study
- Creators
- Lorenzo Ball - Ospedale Policlinico San MartinoChiara Robba - Ospedale Policlinico San MartinoJacob Herrmann - Boston UniversitySarah E. Gerard - University of IowaYi Xin - Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United StatesMaria Pigati - University of GenoaAndrea Berardino - University of GenoaFrancesca Iannuzzi - University of GenoaDenise Battaglini - Ospedale Policlinico San MartinoIole Brunetti - Ospedale Policlinico San MartinoGiuseppe Minetti - Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, BrazilSara Seitun - Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, BrazilAntonio Vena - Ospedale Policlinico San MartinoDaniele Roberto Giacobbe - Ospedale Policlinico San MartinoMatteo Bassetti - Boston UniversityPatricia R.M. Rocco - University of PennsylvaniaMaurizio Cereda - University of PennsylvaniaLucio Castellan - Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, BrazilNicolò Patroniti - Ospedale Policlinico San MartinoPaolo Pelosi - University of GenoaGEnoa COVID-19 Group
- Resource Type
- Journal article
- Publication Details
- Respiratory physiology & neurobiology, Vol.301, pp.103889-103889
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.resp.2022.103889
- PMID
- 35307564
- PMCID
- PMC8928743
- ISSN
- 1569-9048
- eISSN
- 1878-1519
- Language
- English
- Date published
- 07/2022
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering
- Record Identifier
- 9984306834602771
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