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Non-invasive CPAP in mild and moderate ARDS secondary to SARS-CoV-2

•Helmet CPAP is effective to treat mild and moderate ARDS secondary to SARS COV 2.•Lung recruitment is not the only pathological mechanism responsible of CPAP effect.•Patients that improve PaO2/FiO2 ratio after one hour of CPAP have a lower mortality. During the COVID-19 outbreak, a very high number...

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Published in:Respiratory physiology & neurobiology 2020-09, Vol.280, p.103489-103489, Article 103489
Main Authors: 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.
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Language:English
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Summary:•Helmet CPAP is effective to treat mild and moderate ARDS secondary to SARS COV 2.•Lung recruitment is not the only pathological mechanism responsible of CPAP effect.•Patients that improve PaO2/FiO2 ratio after one hour of CPAP have a lower mortality. 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. 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. 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. 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.
ISSN:1569-9048
1878-1519
1878-1519
DOI:10.1016/j.resp.2020.103489