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Minerva Medica 2020 Sep 30

DOI: 10.23736/S0026-4806.20.06952-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Continuous positive airway pressure and pronation outside the intensive care unit in COVID 19 ARDS

Giuseppe A. RAMIREZ 1, 2, Enrica P. BOZZOLO 3, Elena CASTELLI 4, Alessandro MARINOSCI 3, Piera ANGELILLO 5, Sarah DAMANTI 3, Raffaella SCOTTI 3, Agnese GOBBI 2, 3, Clarissa CENTURIONI 2, 3, Flavia DI SCALA 2, 3, Anna MORGILLO 2, 3, Antonella CASTAGNA 2, 6, Caterina CONTE 2, 7, Andrea ASSANELLI 5, Francesco DE COBELLI 2, 8, Barbara CALCATERRA 9, Luca CABRINI 10, 11, Francesco CARCÓ 12, Stefano TURI 12, Paolo SILVANI 12, Lorenzo DAGNA 1, 2, Alberto ZANGRILLO 2, 12, Giovanni LANDONI 2, 12 , Moreno TRESOLDI 3, for the Covid-19 BioB Study Group

1 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; 2 Vita-Salute San Raffaele University, Milan, Italy; 3 Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 4 Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 5 Unit of Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 6 Unit of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy; 7 Unit of Organ Transplants, IRCCS San Raffaele Scientific Institute, Milan, Italy; 8 Unit of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 9 Emergency Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 10 Università degli Studi dell’Insubria, Varese, Italy; 11 Ospedale di Circolo e Fondazione Macchi, ASST-Settelaghi, Varese, Italy; 12 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; 13 Unit of Internal Medicine and Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 14 Unit of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 15 Unit of General Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; 16 Unit of Internal Medicine and Endocrinology, IRCCS San Raffaele Scientific Institute, Milan, Italy; 17 Unit of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy



BACKGROUND: The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the ntensive care unit during a pandemic.
METHODS: In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure = 10 cm H2O, FiO2 = 0.6, daily treatment duration: 4x3hcycles) and respiratory physiotherapy including pronation outside the intensive care unit were followed up.
RESULTS: Of 90 ARDS patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the intensive care unit and with a median (interquartile) follow up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (p=0.033). No safety issues were observed.
CONCLUSIONS: Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the intensive care unit setting during the pandemic.


KEY WORDS: COVID-19; Acute respiratory distress syndrome; Continuous positive airway pressure; Non-invasive ventilation; Pronation; Respiratory physiotherapy

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