https://doi.org/10.4081/ecj.2023.11274

Evaluation of PaCO2 trend in COVID-19 patients undergoing helmet CPAP in the emergency department

Vol. 19 No. 2 (2023): In Memory of Barbara Capovani
Submitted: 24 February 2023
Accepted: 28 April 2023
Published: 23 June 2023
Helmet, CPAP, non-invasive ventilation, COVID-19, hypoxemic respiratory failure
Abstract Views: 871
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Authors

Nicolo Capsoni
nicolo.capsoni@gmail.com
https://orcid.org/0000-0003-2758-4408
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Daniele Privitera
https://orcid.org/0000-0001-5804-5488
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Chiara Airoldi
Department of Translation Medicine, University of Piemonte Orientale, Novara, Italy.
Silvia Gheda
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Annamaria Mazzone
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Gianluca Terranova
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Filippo Galbiati
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Andrea Bellone
https://orcid.org/0000-0001-9253-8251
Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.

The use of continuous positive airway pressure (CPAP) in COVID-19 hypoxemic respiratory failure (h-ARF) under a strict protocol has been described to be highly efficient. However, early prediction of failure is crucial to avoid delayed intubation. Lower PaCO2 values may represent a higher inspiratory effort and, therefore, may help identify patients at greatest risk of CPAP failure. Aim of this study was to observe the PaCO2 trend of COVID-19 patients with h-ARF before and after the initial treatment with helmet-CPAP. A case series study was conducted from November 2020 to March 2021. All adult patients with h-ARF secondary to COVID-19 treated with helmet-CPAP and eligible for endotracheal intubation were observed. Of a total of 54 patients, 32 (59.3%) underwent intubation. Seven (12.9%) patients died in the ETI group, and none in the non-ETI group. Median PaO2/FiO2 ratio on admission was 91mmHg [IQR 68-185] vs. 104mmHg [IQR 85-215] (p=0.137) in the ETI e non-ETI group, respectively. No differences were found either for PaCO2 values on admission (31.5mmHg [IQR 27-35] vs. 29.3mmHg [IQR 27.7-40]) and for PaCO2 variations after 120 minutes of CPAP (+2.38mmHg ± 3.65 vs. +2.73mmHg ± 3.96). Changes in PaCO2 values were observed during an initial helmet-CPAP trial, but no differences were found in those undergoing endotracheal intubation as compared to the others.

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How to Cite

Capsoni, N., Privitera, D., Airoldi, C., Gheda, S., Mazzone, A., Terranova, G., Galbiati, F., & Bellone, A. (2023). Evaluation of PaCO<sub>2</sub> trend in COVID-19 patients undergoing helmet CPAP in the emergency department. Emergency Care Journal, 19(2). https://doi.org/10.4081/ecj.2023.11274
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