Non-invasive respiratory support in SARS-CoV-2 related acute respiratory distress syndrome: when is it most appropriate to start treatment?
Riccardo Nevola, Antonio Russo, Samuel Scuotto, Simona Imbriani, Concetta Aprea, Marianna Abitabile, Domenico Beccia, Chiara Brin, Caterina Carusone, Francesca Cinone, Giovanna Cirigliano, Sara Colantuoni, Domenico Cozzolino, Giovanna Cuomo, Micol Del Core, Klodian Gjeloshi, Aldo Marrone, Giulia Medicamento, Luciana Agnese Meo, Francesco Nappo, Andrea Padula, Pia Clara Pafundi, Roberta Ranieri, Carmen Ricozzi, Luca Rinaldi, Ciro Romano, Rachele Ruocco, Carolina Ruosi, Annabella Salvati, Ferdinando Carlo Sasso, Ausilia Sellitto, Pino Sommese, Angela Villani, Nicola Coppola, Luigi Elio Adinolfi
Abstract
BACKGROUND: Acute respiratory distress syndrome (ARDS) is one of the most severe complications of SARS-CoV-2 infection. Non-Invasive Respiratory Support (NRS) as Continuous Positive Airway Pressure (CPAP) and/or Non-Invasive Ventilation (NIV) has been proven as effective in the management of SARS-CoV-2-related ARDS. However, the most appropriate timing for start NRS is unknown. METHODS: -P/F) at NRS beginning: group A started CPAP/NIV when P/F was ≤ 200 and group B started CPAP/NIV when P/F was ≤ 150. Eligible patients who did not give their consent to CPAP/NIV until the severe stage of ARDS and started non-invasive treatment when P/F ≤ 100 (group C) was added. The considered outcomes were in-hospital mortality, oro-tracheal intubation (OTI) and days of hospitalization. RESULTS: Among 146 eligible patients, 29 underwent CPAP/NIV when P/F was ≤ 200 (Group A), 68 when P/F was ≤ 150 (Group B) and 31 patients agreed to non-invasive treatment only when P/F was ≤ 100 (Group C). Starting NRS at P/F level between 151 and 200 did not results in significant differences in the outcomes as compared to treatment starting with P/F ranging 101-150. Conversely, patients undergone CPAP/NIV in a moderate stage (P/F 101-200) had a significantly lower in-hospital mortality rate (13.4 vs. 29.0%, p = 0.044) and hospitalization length (14 vs. 15 days, p = 0.038) than those in the severe stage (P/F ≤ 100). Age and need for continuous ventilation were independent predictors of CPAP/NIV failure. CONCLUSIONS: Starting CPAP/NIV in patients with SARS-CoV-2-related ARDS in moderate stage (100 > P/F ≤ 200) is associated to a reduction of both in-hospital mortality and hospitalization length compared to the severe stage (P/F ≤ 100). Starting CPAP/NIV with a P/F > 150 does not appear to be of clinical utility.