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: 856
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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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Scopus
Google Scholar
Europe PMC
Brusasco C, Corradi F, Dazzi F, et al. The use of continuous positive airway pressure during the second and third waves of the COVID-19 pandemic. ERJ Open Res 2023;9:00365-2022. DOI: https://doi.org/10.1183/23120541.00365-2022
Brusasco C, Corradi F, Di Domenico A, et al. Continuous positive airway pressure in COVID-19 patients with moderate-Tosevere respiratory failure. Eur Res J 2021;57:10-13. DOI: https://doi.org/10.1183/13993003.02524-2020
Corradi F, Brusasco C. The puzzle of non-invasive respiratory support in COVID-19. Minerva Anestesiologica 2023;89:7-9. DOI: https://doi.org/10.23736/S0375-9393.22.17152-X
Winck JC, Scala R. Non Invasive Respiratory Support Therapies in COVID-19 Related Acute Respiratory Failure: Looking at the Neglected Issues. Arch Bronconeumol 2021;57:9-10. DOI: https://doi.org/10.1016/j.arbres.2021.02.007
Bellani G, Grasselli G, Cecconi M, et al. Noninvasive ventilatory support of patients with covid-19 outside the intensive care units (ward-covid). Ann Am Thor Soc 2021;18:1020-6. DOI: https://doi.org/10.1513/AnnalsATS.202008-1080OC
Tonelli R, Fantini R, Tabbì L, et al. Early inspiratory effort assessment by esophageal manometry predicts noninvasive ventilation outcome in de novo respiratory failure: A pilot study. Am J Resp Critical Care Med 2020;202:558-67. DOI: https://doi.org/10.1164/rccm.201912-2512OC
Spinelli E, Marongiu I, Mauri T. Control of Respiratory Drive by Noninvasive Ventilation as an Early Predictor of Success. Am J Res Critical Care Med 2020;202:1737-8. DOI: https://doi.org/10.1164/rccm.202007-2928LE
Bose E, Hoffman L, Hravnak M. Monitoring cardiorespiratory instability: Current approaches and implications for nursing practice. Intens Critical Care Nurs 2016;34:12-9. DOI: https://doi.org/10.1016/j.iccn.2015.11.005
Privitera D, Mazzone A, Vailati P, et al. Improving Helmet CPAP Use During COVID-19 Pandemic: A Multidisciplinary Approach in the Emergency Department. Dimens Crit Care Nurs 2022;41:178-81. DOI: https://doi.org/10.1097/DCC.0000000000000534
Grieco DL, Menga LS, Cesarano M, et al. Effect of Helmet Noninvasive Ventilation vs High-Flow Nasal Oxygen on Days Free of Respiratory Support in Patients With COVID-19 and Moderate to Severe Hypoxemic Respiratory Failure: The HENIVOT Randomized Clinical Trial. JAMA 2021;325:1731-43. DOI: https://doi.org/10.1001/jama.2021.4682
Privitera D, Angaroni L, Capsoni N, et al. Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department. Intern Emerg Med 2020;15:767-71. DOI: https://doi.org/10.1007/s11739-020-02370-8
Chung M, Bernheim A, Mei X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology 2020;295:202-7. DOI: https://doi.org/10.1148/radiol.2020200230
Bellani G, Patroniti N, Greco M, et al. The use of helmets to deliver non-invasive continuous positive airway pressure in hypoxemic acute respiratory failure. Minerva Anestesiol 2008;74:651-6.
Privitera D, Capsoni N, Zadek F, et al. Flow generators for helmet CPAP: Which to prefer? A bench study. Intensive Crit Care Nurs 2023;74:103344. DOI: https://doi.org/10.1016/j.iccn.2022.103344
Cabrini L, Landoni G, Zangrillo A. Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure. Lancet 2020;395:685. DOI: https://doi.org/10.1016/S0140-6736(20)30359-7
Privitera D, Capsoni N, Zadek F, et al. The Effect of Filters on CPAP Delivery by Helmet. Respir Care 2022;67:995-1001. DOI: https://doi.org/10.4187/respcare.09822
Lucchini A, Elli S, Bambi S, et al. How different helmet fixing options could affect patients' pain experience during helmet-continuous positive airway pressure. Nurs Crit Care 2019;24:369-74. DOI: https://doi.org/10.1111/nicc.12399
Bellani G, Laffey JG, Pham T, et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med 2017;195:67-77. DOI: https://doi.org/10.1164/rccm.201606-1306OC
Demoule A, Girou E, Richard JC, Taille S, Brochard L. Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med 2006;32:1756-65. DOI: https://doi.org/10.1007/s00134-006-0324-1
Corradi F, Isirdi A, Malacarne P, et al. Low diaphragm muscle mass predicts adverse outcome in patients hospitalized for COVID-19 pneumonia: An exploratory pilot study. Minerva Anestesiologica 2021;87:432-8. DOI: https://doi.org/10.23736/S0375-9393.21.15129-6
Corradi F, Vetrugno L, Orso D, et al. Diaphragmatic thickening fraction as a potential predictor of response to continuous positive airway pressure ventilation in COVID-19 pneumonia: A single-center pilot study. Respir Physiol Neurobiol 2021;284:103585. DOI: https://doi.org/10.1016/j.resp.2020.103585

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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