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Non-invasive CPAP in mild and moderate ARDS secondary to SARS-CoV-2.
Respir Physiol Neurobiol. 2020 09; 280:103489.RP

Abstract

BACKGROUND

During the COVID-19 outbreak, a very high number of infected patients developed pneumonia and many of them complicated with acute respiratory distress syndrome. The optimal management of respiratory failure and the role of lung ultrasound imaging in the evaluation of efficacy of treatment are unknown.

METHODS

In March 2020 we treated 18 patients with mild and moderate ARDS secondary to SARS-CoV-2 with non-invasive continuous positive airway pressure therapy (NI-CPAP). All patients underwent lung ultrasound imaging to verify the entity of lung recruitment after NI-CPAP initiation.

RESULTS

After one hour of treatment we observed a significant improvement in PaO2/FiO2 ratio in 10 patients. Notably, only 50 % of them reached an effective improvement in lung aeration detectable with lung ultrasound. In the other 50 % or patients the improvement in PaO2/FiO2 might be related to blood redistribution and reverse of hypoxic vasoconstriction.

CONCLUSION

NI- CPAP is a valid therapeutic option in mild and moderate ARDS secondary SARS-CoV-2. Lung recruitment detected by means of lung ultrasound is a relevant but not the exclusive mechanism that underlies the therapeutic efficacy of NI-CPAP in this clinical setting.

Authors+Show Affiliations

Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy. Electronic address: antoniopag82@gmail.com.it.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.Federico II University, Italy.Emergency Department, Santa Maria delle Grazie Hospital Naples, ASL Napoli 2 Nord, Italy.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32629100

Citation

Pagano, A, et al. "Non-invasive CPAP in Mild and Moderate ARDS Secondary to SARS-CoV-2." Respiratory Physiology & Neurobiology, vol. 280, 2020, p. 103489.
Pagano A, Porta G, Bosso G, et al. Non-invasive CPAP in mild and moderate ARDS secondary to SARS-CoV-2. Respir Physiol Neurobiol. 2020;280:103489.
Pagano, A., Porta, G., Bosso, G., Allegorico, E., Serra, C., Dello Vicario, F., Minerva, V., Russo, T., Altruda, C., Arbo, P., Mercurio, V., & Numis, F. G. (2020). Non-invasive CPAP in mild and moderate ARDS secondary to SARS-CoV-2. Respiratory Physiology & Neurobiology, 280, 103489. https://doi.org/10.1016/j.resp.2020.103489
Pagano A, et al. Non-invasive CPAP in Mild and Moderate ARDS Secondary to SARS-CoV-2. Respir Physiol Neurobiol. 2020;280:103489. PubMed PMID: 32629100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-invasive CPAP in mild and moderate ARDS secondary to SARS-CoV-2. AU - Pagano,A, AU - Porta,G, AU - Bosso,G, AU - Allegorico,E, AU - Serra,C, AU - Dello Vicario,F, AU - Minerva,V, AU - Russo,T, AU - Altruda,C, AU - Arbo,P, AU - Mercurio,V, AU - Numis,F G, Y1 - 2020/07/03/ PY - 2020/05/20/received PY - 2020/06/23/revised PY - 2020/07/01/accepted PY - 2020/7/7/pubmed PY - 2020/9/10/medline PY - 2020/7/7/entrez KW - COVID 19 KW - Coronavirus KW - SARS COV 2 SP - 103489 EP - 103489 JF - Respiratory physiology & neurobiology JO - Respir Physiol Neurobiol VL - 280 N2 - BACKGROUND: During the COVID-19 outbreak, a very high number of infected patients developed pneumonia and many of them complicated with acute respiratory distress syndrome. The optimal management of respiratory failure and the role of lung ultrasound imaging in the evaluation of efficacy of treatment are unknown. METHODS: In March 2020 we treated 18 patients with mild and moderate ARDS secondary to SARS-CoV-2 with non-invasive continuous positive airway pressure therapy (NI-CPAP). All patients underwent lung ultrasound imaging to verify the entity of lung recruitment after NI-CPAP initiation. RESULTS: After one hour of treatment we observed a significant improvement in PaO2/FiO2 ratio in 10 patients. Notably, only 50 % of them reached an effective improvement in lung aeration detectable with lung ultrasound. In the other 50 % or patients the improvement in PaO2/FiO2 might be related to blood redistribution and reverse of hypoxic vasoconstriction. CONCLUSION: NI- CPAP is a valid therapeutic option in mild and moderate ARDS secondary SARS-CoV-2. Lung recruitment detected by means of lung ultrasound is a relevant but not the exclusive mechanism that underlies the therapeutic efficacy of NI-CPAP in this clinical setting. SN - 1878-1519 UR - https://www.unboundmedicine.com/medline/citation/32629100/Non_invasive_CPAP_in_mild_and_moderate_ARDS_secondary_to_SARS_CoV_2_ DB - PRIME DP - Unbound Medicine ER -