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Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia

Authors

Stefano De Vuono
https://orcid.org/0000-0001-6533-5205
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Sokol Berisha
https://orcid.org/0009-0009-9437-8664
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Laura Settimi
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Pasquale Cianci
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Alessandra Lignani
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Gianmarco Lanci
https://orcid.org/0009-0002-6235-3808
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Maria Rita Taliani
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.
Paolo Groff
paolo.groff@ospedale.perugia.it
https://orcid.org/0000-0001-9941-6193
Emergency Department, Santa Maria della Misericordia Hospital, Perugia, Italy.

Background: SARS-CoV-2 related pneumonia is characterized by moderate-to severe hypoxemia often associated with hypocapnia the prognostic role of which is poorely documented.

Aims: evaluate if hypocapnia can predict the need for non-invasive mechanical ventilation (NIMV) in this setting.

Materials and methods: we prospectively studied 52 subjects with moderate-severe SARS-CoV-2 related pneumonia. All the following data were collected at admission to the Emergency Department and processed by univariate and multivariate analysis: clinical and laboratory data, blood gas analysis in room air and lung ultrasound.

Results: 33/52 subjects (63,4%) underwent NIMV. At univariate analysis PaCO2 was inversely associated to the need for NIMV (OR 0,82, CI 95% 0,689-0,976, p .025). At multivariate analysis PaCO2 predicted the need for NIMV independently from age, gender, number of comorbidities, d-dimer, CRP, PaO2 and LUS SCORE (OR 0,838, CI 95% 0,710-0,988, p .035).

Conclusions: our data suggest that hypocapnia could be an early predictor of clinical worsening in these patients independently from other known predictors of unfavourable outcome, reflecting the occurrence of a deep and frequent respiratory pattern possibly related to the generation of excessive transpulmonary pressure swings leading to a self-induced lung injury (P-SILI). Further studies are needed for validating these data on greater populations.

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How to Cite

De Vuono, S., Berisha, S., Settimi, L., Cianci, P., Lignani, A., Lanci, G., Taliani, M. R., & Groff, P. (2023). Hypocapnia as a predictor of the need for non-invasive mechanical ventilation in subjects with SARS-CoV-2 related pneumonia. Emergency Care Journal, 19(1). https://doi.org/10.4081/ecj.2023.11237
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