目的:持续气道正压通气(CPAP)是COVID-19急性呼吸窘迫综合征(ARDS)的重要治疗工具,因为它可以改善氧合,降低呼吸频率,并可防止插管和重症监护病房(ICU)入院。内旋期间的CPAP很少被描述,在镇静期间从未被描述。
方法:案例系列。
方法:圣卡洛大学医院高依赖单位(Potenza,意大利)。
方法:11例连续COVID-19ARDS患者。
方法:仰卧位CPAP试验失败后俯卧位头盔CPAP。
■在基线时收集数据,然后在内旋24、48和72小时后收集数据。我们测量了PaO2/FIO2,pH,乳酸,在28天随访患者的PaCO2、SpO2、呼吸频率和状态。
结果:患者接受头盔式CPAP治疗,平均±SD为7±2.7天。俯卧定位对所有患者都是可行的,但其中右美托咪定改善了7。PaO2/FIO2从开始内旋前的107.5±20.8提高到72h后的244.4±106.2(p<.001)。我们还观察到Sp02从90.6±2.3显着增加到96±3.1(p<.001),呼吸频率从27.6±4.3降低到20.1±4.7(p=.004)。在PaCO2或pH中未观察到差异。28天时,两名患者在入住ICU后死亡,1人在入住ICU后在主病房出院,8人在ICU外成功管理后出院。
结论:头旋期间头盔式CPAP在ICU外管理的COVID-19ARDS中是可行且安全的,右美托咪定的镇静可以安全地改善舒适度。我们记录了PaO2/FIO2,SpO2的增加和呼吸频率的降低。
OBJECTIVE: Continuous positive airway pressure (
CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission.
CPAP during pronation has seldom been described and never during sedation.
METHODS: Case series.
METHODS: High dependency unit of San Carlo University Hospital (Potenza, Italy).
METHODS: Eleven consecutive patients with COVID-19 ARDS.
METHODS: Helmet
CPAP in prone position after failing a
CPAP trial in the supine position.
UNASSIGNED: Data collection at baseline and then after 24, 48 and 72h of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up.
RESULTS: Patients were treated with helmet
CPAP for a mean±SD of 7±2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72h (p<.001). We also observed a significantly increase in Sp02 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU.
CONCLUSIONS: Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.