CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU
ABSTRACT Objective: This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation. Methods: This was a retrospective cohort study involving patients with COVID...
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Sociedade Brasileira de Pneumologia e Tisiologia
2024-12-01
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| Series: | Jornal Brasileiro de Pneumologia |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132024000500603&lng=en&tlng=en |
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| author | Isabella de Melo Matos Betina Santos Tomaz Maria da Penha Uchoa Sales Gabriela Carvalho Gomes Antonio Brazil Viana Junior Miguel R. Gonçalves Marcelo Alcantara Holanda Eanes Delgado Barros Pereira |
| author_facet | Isabella de Melo Matos Betina Santos Tomaz Maria da Penha Uchoa Sales Gabriela Carvalho Gomes Antonio Brazil Viana Junior Miguel R. Gonçalves Marcelo Alcantara Holanda Eanes Delgado Barros Pereira |
| author_sort | Isabella de Melo Matos |
| collection | DOAJ |
| description | ABSTRACT Objective: This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation. Methods: This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed. Results: The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation. Conclusions: ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality. |
| format | Article |
| id | doaj-art-3377a3f09d2f4d3eaa2b4298e4fdeea4 |
| institution | OA Journals |
| issn | 1806-3756 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Sociedade Brasileira de Pneumologia e Tisiologia |
| record_format | Article |
| series | Jornal Brasileiro de Pneumologia |
| spelling | doaj-art-3377a3f09d2f4d3eaa2b4298e4fdeea42025-08-20T01:58:23ZengSociedade Brasileira de Pneumologia e TisiologiaJornal Brasileiro de Pneumologia1806-37562024-12-0150510.36416/1806-3756/e20240299CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICUIsabella de Melo Matoshttps://orcid.org/0009-0007-5891-2992Betina Santos Tomazhttps://orcid.org/0000-0002-2523-7296Maria da Penha Uchoa Saleshttps://orcid.org/0000-0002-4226-6216Gabriela Carvalho Gomeshttps://orcid.org/0000-0002-9342-7737Antonio Brazil Viana Juniorhttps://orcid.org/0000-0001-6608-3134Miguel R. Gonçalveshttps://orcid.org/0000-0001-7943-9507Marcelo Alcantara Holandahttps://orcid.org/0000-0002-6002-0084Eanes Delgado Barros Pereirahttps://orcid.org/0000-0002-4414-3164ABSTRACT Objective: This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation. Methods: This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed. Results: The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation. Conclusions: ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132024000500603&lng=en&tlng=enRespiratory distress syndromeCOVID-19Continuous positive airway pressurehelmetsDexmedetomidine |
| spellingShingle | Isabella de Melo Matos Betina Santos Tomaz Maria da Penha Uchoa Sales Gabriela Carvalho Gomes Antonio Brazil Viana Junior Miguel R. Gonçalves Marcelo Alcantara Holanda Eanes Delgado Barros Pereira CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU Jornal Brasileiro de Pneumologia Respiratory distress syndrome COVID-19 Continuous positive airway pressure helmets Dexmedetomidine |
| title | CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU |
| title_full | CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU |
| title_fullStr | CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU |
| title_full_unstemmed | CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU |
| title_short | CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU |
| title_sort | cpap delivered via a helmet interface in lightly sedated patients with moderate to severe ards predictors of success outside the icu |
| topic | Respiratory distress syndrome COVID-19 Continuous positive airway pressure helmets Dexmedetomidine |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132024000500603&lng=en&tlng=en |
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