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ORIGINAL ARTICLE
Minerva Medica 2022 April;113(2):281-90
DOI: 10.23736/S0026-4806.20.06952-9
Copyright © 2020 EDIZIONI MINERVA MEDICA
language: English
Continuous positive airway pressure and pronation outside the Intensive Care Unit in COVID-19 acute respiratory distress syndrome
Giuseppe A. RAMIREZ 1, 2, Enrica P. BOZZOLO 3, Elena CASTELLI 4, Alessandro MARINOSCI 3, Piera ANGELILLO 5, Sarah DAMANTI 3, Raffaella SCOTTI 3, Agnese GOBBI 2, 3, Clarissa CENTURIONI 2, 3, Flavia DI SCALA 2, 3, Anna MORGILLO 2, 3, Antonella CASTAGNA 2, 6, Caterina CONTE 2, 7, Andrea ASSANELLI 5, Francesco DE COBELLI 2, 8, Barbara CALCATERRA 9, Luca CABRINI 10, 11, Francesco CARCÒ 12, Stefano TURI 12, Paolo SILVANI 12, Lorenzo DAGNA 1, 2, Alberto ZANGRILLO 2, 12, Giovanni LANDONI 2, 12 ✉, Moreno TRESOLDI 3 Covid-19 BioB Study Group 
1 Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Milan, Italy; 2 Vita-Salute San Raffaele University, Milan, Italy; 3 Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Milan, Italy; 4 Department of Cardiothoracic, IRCCS San Raffaele Hospital, Milan, Italy; 5 Unit of Hematology, IRCCS San Raffaele Hospital, Milan, Italy; 6 Unit of Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy; 7 Unit of Organ Transplants, IRCCS San Raffaele Hospital, Milan, Italy; 8 Unit of Radiology, IRCCS San Raffaele Hospital, Milan, Italy; 9 Emergency Department, IRCCS San Raffaele Hospital, Milan, Italy; 10 University of Insubria, Varese, Italy; 11 Ospedale di Circolo e Fondazione Macchi, ASST-Settelaghi, Varese, Italy;12 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
BACKGROUND: The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the Intensive Care Unit during a pandemic.
METHODS: In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure =10 cm H
RESULTS: Of 90 acute respiratory distress syndrome (ARDS) patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the Intensive Care Unit and with a median (interquartile) follow-up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (P=0.033). No safety issues were observed.
CONCLUSIONS: Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the Intensive Care Unit setting during the pandemic.
KEY WORDS: COVID-19; Respiratory distress syndrome; Continuous positive airway pressure; Noninvasive ventilation; Pronation
