https://doi.org/10.4081/ecj.2023.11237

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

Vol. 19 No. 1 (2023)
Submitted: 3 February 2023
Accepted: 3 March 2023
Published: 28 March 2023
hypocapnia, NIMV, SARS-CoV-2
Abstract Views: 905
PDF: 280
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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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Citations

Crossref
Scopus
Google Scholar
Europe PMC
WHO. WHO Coronavirus (COVID-19) Dashboard. Accessed: 27th January 2023. Available from: https://covid19.who.int
Wynants L, Van Calster B, Collins GS, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ 2020;369:m1328
Booth A, Reed AB, Ponzo S, et al. Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis. PLoS ONE 2021;16:e0247461. DOI: https://doi.org/10.1371/journal.pone.0247461
Chu K, Alharahsheh B, Garg N, et al. Evaluating risk stratification scoring systems to predict mortality in patients with COVID-19. BMJ Health Care Inform 2021;28:e100389. DOI: https://doi.org/10.1136/bmjhci-2021-100389
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72,314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42. DOI: https://doi.org/10.1001/jama.2020.2648
Tobin MJ, Laghi F, Jubran A. Why COVID-19 silent hypoxemia is baffling to physicians. Am J Respir Crit Care Med 2020;202:356-360. DOI: https://doi.org/10.1164/rccm.202006-2157CP
Dhont S, Derom E, Van Braeckel E, Depuydt P, Lambrecht BN. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res 2020;21:198. DOI: https://doi.org/10.1186/s12931-020-01462-5
Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med 2019;199:701–14. DOI: https://doi.org/10.1164/rccm.201802-0236CI
Gattinoni L, Gattarello S, Steinberg I, et al. COVID-19 pneumonia: pathophysiology and management. Eur Respir Rev 2021;30:210138. DOI: https://doi.org/10.1183/16000617.0138-2021
Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med 2017;195:438-42. DOI: https://doi.org/10.1164/rccm.201605-1081CP
Grieco DL, Menga LS, Eleuteri D, Antonelli M. Patient self-inflicted lung injury: implications for acute hypoxemic respiratory failure and ARDS patients on non-invasive support. Minerva Anesthesiol 2019;85:1014-23. DOI: https://doi.org/10.23736/S0375-9393.19.13418-9
Crimi C, Noto A, Madotto F, et al. High-flow nasal oxygen versus conventional oxygen therapy in patients with COVID-19 pneumonia and mild hypoxaemia: a randomised controlled trial. Thorax 2022;0:1–8. DOI: https://doi.org/10.1136/thoraxjnl-2022-218806
Prediletto I, D’Antoni L, Carbonara P et al. Standardizing PaO2 for PaCO2 in P/F ratio predicts in-hospital mortality in acute respiratory failure due to COVID-19: a pilot prospective study. Eur J Intern Med 2021;92:48-54. DOI: https://doi.org/10.1016/j.ejim.2021.06.002
Maraziti G, Becattibi C. Early variation of respiratory indexes to predict death or ICU admission in severe acute respiratory syndrome coronavirus-2-related respiratory failure. Respiration 2022;101:632-637. DOI: https://doi.org/10.1159/000522275
Gupta B, Jain G, Chandrakar S, Gupta N, Agarwal A. Arterial blood gas as a predictor of mortality in COVID pneumonia patients initiated on noninvasive mechanical ventilation: a retrospective analysis. Indian J Crit Care Med 2021;25:866–71. DOI: https://doi.org/10.5005/jp-journals-10071-23917
De Vuono S, Cianci P, Berisha S, et al. The PaCO2/FiO2 ratio as outcome predictor in SARS-COV-2 related pneumonia: a retrospective study. Acta Biomed 2022;93:e2022256.
Gianstefani A, Farina G, Salvatore V, et al. Role of ROX index in the first assessment of COVID-19 patients in the emergency department. Intern Emerg Med 2021;16:1959–65. DOI: https://doi.org/10.1007/s11739-021-02675-2

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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