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Italian Journal of Emergency Medicine 2021 December;10(3):150-2

DOI: 10.23736/S2532-1285.21.00122-1

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

Non-invasive respiratory support in COVID-19 pneumonia: how to do it

Roberto COSENTINI 1 , Rodolfo FERRARI 2, Anna M. BRAMBILLA 3, Paolo GROFF 4

1 High Specialization Emergency (EAS), ASST Papa Giovanni XXIII, Bergamo, Italy; 2 First Aid and Emergency Medicine Department, S. Maria della Scaletta Hospital, Imola, Bologna, Italy; 3 First Aid and Emergency Medicine Department, ASST Fatebenefratelli-Sacco, Sacco University Hospital, Milan, Italy; 4 First Aid and Emergency Medicine Department, Hospital of Perugia, Perugia, Italy

In this paper, the clinical scenario of a patient presenting in the ED with COVID-19 pneumonia is described step-by-step through the oxygen escalation pathway. For each step, indication, initial setting, and clinical failure criteria are provided: 1) step 1 (oxygen treatment - escalation from nasal prongs to Venturi mask to non-rebreathing mask, in order to achieve a target SO2 of 92-94%); 2) step 2 (high-flow nasal cannula oxygenation - start with flow at 50 L/min, temperature 34°C and adjust FiO2 according to the SO2 target); 3) step 3 (CPAP -start with PEEP 5 cmH2O and titrate FiO2 to the SO2 target); 4) step 4 (NIPPV - start with PEEP 5 cmH2O and pressure support of 10 cmH2O titrated to reach a target exhaled tidal volume of 4-6 mL/kg [IBW]); 4) from step 1-4 (awake self-repositioning/pronation - encourage patients to change his/her body position lying on one lateral side, then in the prone position with his chest upon a pillow, and finally to the other lateral side, monitoring vitals and SpO2 to see whether SpO2 rises to the target value of 92-94%. Successful position should be maintained for at least 2 hours). Finally, identify early NIPPV failure in clinical (anxiety, confusion, increased work of breathing, respiratory distress) and/or ABG terms (pO2, pH and pCO2), since delayed intubation worsens our patients’ prognosis.

KEY WORDS: COVID-19; Oxygen inhalation therapy; Continuous positive airway pressure; Pronation

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