Severity of respiratory failure and outcome of patients needing a ventilatory
support in the Emergency Department during Italian novel coronavirus SARS-CoV2
outbreak: Preliminary data on the role of Helmet CPAP and Non-Invasive Positive
Pressure Ventilation
#MMPMID32766538
Duca A
; Memaj I
; Zanardi F
; Preti C
; Alesi A
; Della Bella L
; Ghezzi E
; Di Marco F
; Lorini FL
; Venturelli S
; Fagiuoli S
; Cosentini R
EClinicalMedicine
2020[Jul]; 24
(?): 100419
PMID32766538
show ga
BACKGROUND: Novel Coronavirus SARS-CoV-2 pandemic is spreading around the world.
At the end of February, the outburst of the pandemic has hit hard on northern
Italian's hospitals. As of today, no data have been published regarding the
severity of respiratory failure of patients presenting to the Emergency
Departments. Moreover, the outcome the patients forced to undergo Continuous
Positive Airway Pressure (CPAP) or Non-Invasive Positive Pressure Ventilation
(NIPPV) due to lack of Intensive Care resources is unknown. "Papa Giovanni XXIII"
hospital (HPG23) of Bergamo is one of the largest hospitals in the Country, with
an Emergency Department (ED) managing over 100,000 patients per year. METHODS:
This is a retrospective observational study based on chart review of patients
presenting to the Emergency Department of HPG23 from 29/02/2020 to 10/03/2020
with a clinical condition highly suspicious for COVID-19 infection. Registration
of admission rates, severity of respiratory failure (ARDS classification), need
of respiratory support, SARS-CoV-2 PCR test and outcome of patients treated with
a ventilatory support were registered on 10th of May 2020. FINDINGS: From 29/02
to 10/03 611 patients with a suspected diagnosis of COVID-19 infection were
evaluated in our ED; 320 (52%) met the criteria for hospital admission and 99
(31%) needed to be immediately started on ventilatory support (81% CPAP, 7%
NIPPV, 12% Invasive Mechanical Ventilation). Eighty-five (86%) of the 99 patients
needing a ventilatory support eventually had SARS-CoV-2 infection confirmed by
PCR test on nasal-pharyngeal swab. Their median PO2/FiO2 ratio was 128 (IQR
85-168), with 23 patients (29.5%) classified as severe ARDS. Mortality rate as of
10th of May was 76.5%, ranging from 44.4% within patients <60 years old to 85%
within those older than 60 years (p = 0.001). NIPPV/CPAP failure occurred in
91.5% of patients. INTERPRETATION: The population of patients suspected for
COVID-19 infection presenting at our ED showed a very high rate of severe
respiratory failure, with urgent need of a large amount of intensive care
resources. Mortality rates of critically ill patients with confirmed COVID-19
(76.5%) are similar to previously reported studies with similar population.
CPAP/NIPPV could be a valid strategy to treat severely hypoxic patients that
cannot be intubated in the ED due to lack of intensive care resources. FUNDING:
No funds were received for this research project.
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