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Italian Journal of Emergency Medicine 2021 December;10(3):128-33

DOI: 10.23736/S2532-1285.21.00116-6

Copyright © 2021 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

lingua: Inglese

The role of helmet CPAP

Isabelle PIAZZA 1, 2, Eliana MARGUTTI 2, Valentina ROSTI 2, Alessio MARRA 2, Carlo PRETI 1, 2, Andrea DUCA 2, Roberto COSENTINI 2

1 Emergency Medicine School, University of Milan, Milan, Italy; 2 Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy

Continuous positive airway pressure (CPAP) has been diffusely applied outside the Intensive Care Unit in patients with acute hypoxemic respiratory failure (AHRF) due to Coronavirus-19 disease. A PubMed query was performed using the following key words: “COVID-19,” “continuous positive airway pressure,” “respiratory failure,” “pneumonia.” Most recent papers written in English were selected. Studies discussing pathophysiologic issues were prioritized. Reports of single cases were excluded. The content of the selected papers was summarized as a brief narrative review. The use of CPAP in COVID-19 related AHRF is based on the assumption that it may lead to increased resistance in the small vessels of non-dependent regions of the lung, favoring the redistribution of perfusion to newly recruited depending areas when the hypoxic vasoconstriction mechanism is lost. CPAP might reduce the respiratory work and distress and avoid the reduction of the residual functional capacity, improving the compliance of the thoracic-pulmonary system and increasing the percentage of ventilated alveoli. Finally, CPAP might improve the oxygenation even in refractory hypoxemia during conventional oxygen therapy with moderately preserved pulmonary compliance. Always being alert to consider tracheal intubation in patients with clinical signs of unresponsive acute respiratory failure, we suggest the use of CPAP in COVID-19 related AHRF in the first phases of the clinical course, for hemodynamically stable patients, with preserved neurological status, intact respiratory dynamics, elevate respiratory rate and mild-severe desaturation.

KEY WORDS: COVID-19; Continuous positive airway pressure; Pneumonia; Respiratory insufficiency

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