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Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure

The elderly population represents a high percentage of patients hospitalized for COVID-19 pneumonia and severe respiratory failure, for whom CPAP may be a treatment option. The aim of this study was to describe the CPAP support modalities and to explore factors associated with CPAP failure. In this...

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Autores principales: Ceriani, Elisa, Pitino, Annalisa, Radovanovic, Dejan, Salvi, Emanuele, Matone, Maddalena, Teatini, Thomas, Gidaro, Antonio, Tripepi, Giovanni, Santus, Pierachille, Gori, Mercedes, Cogliati, Chiara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369612/
https://www.ncbi.nlm.nih.gov/pubmed/35956070
http://dx.doi.org/10.3390/jcm11154454
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author Ceriani, Elisa
Pitino, Annalisa
Radovanovic, Dejan
Salvi, Emanuele
Matone, Maddalena
Teatini, Thomas
Gidaro, Antonio
Tripepi, Giovanni
Santus, Pierachille
Gori, Mercedes
Cogliati, Chiara
author_facet Ceriani, Elisa
Pitino, Annalisa
Radovanovic, Dejan
Salvi, Emanuele
Matone, Maddalena
Teatini, Thomas
Gidaro, Antonio
Tripepi, Giovanni
Santus, Pierachille
Gori, Mercedes
Cogliati, Chiara
author_sort Ceriani, Elisa
collection PubMed
description The elderly population represents a high percentage of patients hospitalized for COVID-19 pneumonia and severe respiratory failure, for whom CPAP may be a treatment option. The aim of this study was to describe the CPAP support modalities and to explore factors associated with CPAP failure. In this retrospective study, 110 consecutive patients aged ≥ 75 years were enrolled. Median frailty score, baseline partial arterial pressure of oxygen to fraction of inspired oxygen ratio (P/F), and respiratory rate (RR) were 5, 108, and 30 cycles/min, respectively. Of the 110 patients that began CPAP treatment, 17 patients died within 72 h from baseline, while in 2 patients, CPAP was withdrawn for clinical improvement. Thus, of the 91 patients still on CPAP at day 3, 67% of them needed continuous CPAP delivery. Patients with RR ≥ 30 and with frailty score ≥ 5 had an odds ratio of continuous CPAP needing of 3 and 4, respectively. Patients unable to tolerate CPAP-free periods demonstrated higher mortality risk as compared to those able to tolerate intermittent CPAP (OR: 6.04, 95% CI 2.38–16.46, p < 0.001). The overall in-hospital mortality was 63.6%. Delirium occurred in 59.1%, with a mortality rate in this subgroup of 83.1%. In a time-varying Cox model, the hazard ratio of death was 2.9 in patients with baseline RR ≥ 30 cycle/min, 2.4 in those with baseline P/F < 100. In the same model, the hazard ratio of death was 20 in patients with delirium and a frailty score < 5 and 8.8 in those without delirium and with frailty ≥ 5, indicating a competitive effect between these two variables on the death risk. Conclusions: Respiratory impairment, frailty, and delirium predict treatment failure, with the latter two factors demonstrating a competitive effect on mortality risk. CPAP support may represent a feasible therapeutic option in elderly patients, although chances of a therapeutic benefit are markedly reduced in case of severe respiratory impairment, very frail baseline condition or delirium occurrence.
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spelling pubmed-93696122022-08-12 Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure Ceriani, Elisa Pitino, Annalisa Radovanovic, Dejan Salvi, Emanuele Matone, Maddalena Teatini, Thomas Gidaro, Antonio Tripepi, Giovanni Santus, Pierachille Gori, Mercedes Cogliati, Chiara J Clin Med Article The elderly population represents a high percentage of patients hospitalized for COVID-19 pneumonia and severe respiratory failure, for whom CPAP may be a treatment option. The aim of this study was to describe the CPAP support modalities and to explore factors associated with CPAP failure. In this retrospective study, 110 consecutive patients aged ≥ 75 years were enrolled. Median frailty score, baseline partial arterial pressure of oxygen to fraction of inspired oxygen ratio (P/F), and respiratory rate (RR) were 5, 108, and 30 cycles/min, respectively. Of the 110 patients that began CPAP treatment, 17 patients died within 72 h from baseline, while in 2 patients, CPAP was withdrawn for clinical improvement. Thus, of the 91 patients still on CPAP at day 3, 67% of them needed continuous CPAP delivery. Patients with RR ≥ 30 and with frailty score ≥ 5 had an odds ratio of continuous CPAP needing of 3 and 4, respectively. Patients unable to tolerate CPAP-free periods demonstrated higher mortality risk as compared to those able to tolerate intermittent CPAP (OR: 6.04, 95% CI 2.38–16.46, p < 0.001). The overall in-hospital mortality was 63.6%. Delirium occurred in 59.1%, with a mortality rate in this subgroup of 83.1%. In a time-varying Cox model, the hazard ratio of death was 2.9 in patients with baseline RR ≥ 30 cycle/min, 2.4 in those with baseline P/F < 100. In the same model, the hazard ratio of death was 20 in patients with delirium and a frailty score < 5 and 8.8 in those without delirium and with frailty ≥ 5, indicating a competitive effect between these two variables on the death risk. Conclusions: Respiratory impairment, frailty, and delirium predict treatment failure, with the latter two factors demonstrating a competitive effect on mortality risk. CPAP support may represent a feasible therapeutic option in elderly patients, although chances of a therapeutic benefit are markedly reduced in case of severe respiratory impairment, very frail baseline condition or delirium occurrence. MDPI 2022-07-30 /pmc/articles/PMC9369612/ /pubmed/35956070 http://dx.doi.org/10.3390/jcm11154454 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ceriani, Elisa
Pitino, Annalisa
Radovanovic, Dejan
Salvi, Emanuele
Matone, Maddalena
Teatini, Thomas
Gidaro, Antonio
Tripepi, Giovanni
Santus, Pierachille
Gori, Mercedes
Cogliati, Chiara
Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure
title Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure
title_full Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure
title_fullStr Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure
title_full_unstemmed Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure
title_short Continuous Positive Airway Pressure in Elderly Patients with Severe COVID-19 Related Respiratory Failure
title_sort continuous positive airway pressure in elderly patients with severe covid-19 related respiratory failure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369612/
https://www.ncbi.nlm.nih.gov/pubmed/35956070
http://dx.doi.org/10.3390/jcm11154454
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