Long-term outcome of COVID-19 patients treated with helmet noninvasive ventilation vs. high-flow nasal oxygen: a randomized trial

Journal of Intensive Care

Research

Jonathan Montomoli¹  Salvatore M. Maggiore²  Paola Rucci³  Massimo Antonelli⁴  Gabriele Pintaudi⁴  Teresa Michi⁴  Domenico Luca Grieco⁴  Luca S. Menga⁴  Eloisa S. Tanzarella⁴  Edoardo Piervincenzi⁴  Tommaso Rosà⁴  Salvatore L. Cutuli⁴  Maria Grazia Bocci⁴  Melania Cesarano⁴  Giuseppe Bello⁴  Gennaro De Pascale⁴  Giorgio Conti⁴  Chiara Mattana⁴  Maria Rosaria Gualano⁵  Tommaso Tonetti⁶  Savino Spadaro⁷  Elisabetta Rota⁸  Francesco Landi⁸  Matteo Tosato⁸ 

[1] Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy;Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy;Department of Biomedical and Neuromotor Science, Alma Mater Studiorum-Università Di Bologna, Bologna, Italy;Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.Go F. Vito, 00168, Rome, Italy;Istituto Di Anestesiologia E Rianimazione, Catholic University of The Sacred Heart, Rome, Italy;Department of Hygiene and Public Health, UniCamillus University, Rome, Italy;Leadership in Medicine Research Center, Catholic University of The Sacred Heart, Rome, Italy;Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Medicine, Alma Mater Studiorum, Policlinico Di Sant’Orsola, Università Di Bologna, Bologna, Italy;Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliera-Universitaria Arcispedale Sant’Anna, University of Ferrara, Ferrara, Italy;Geriatrics Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;

关键词: COVID-19;    Noninvasive ventilation;    Helmet;    High-flow nasal oxygen;    Acute respiratory failure;    Patient self-inflicted lung injury (P-SILI);   

DOI  :  10.1186/s40560-023-00669-0

 received in 2023-02-10, accepted in 2023-05-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundLong-term outcomes of patients treated with helmet noninvasive ventilation (NIV) are unknown: safety concerns regarding the risk of patient self-inflicted lung injury and delayed intubation exist when NIV is applied in hypoxemic patients. We assessed the 6-month outcome of patients who received helmet NIV or high-flow nasal oxygen for COVID-19 hypoxemic respiratory failure.MethodsIn this prespecified analysis of a randomized trial of helmet NIV versus high-flow nasal oxygen (HENIVOT), clinical status, physical performance (6-min-walking-test and 30-s chair stand test), respiratory function and quality of life (EuroQoL five dimensions five levels questionnaire, EuroQoL VAS, SF36 and Post-Traumatic Stress Disorder Checklist for the DSM) were evaluated 6 months after the enrollment.ResultsAmong 80 patients who were alive, 71 (89%) completed the follow-up: 35 had received helmet NIV, 36 high-flow oxygen. There was no inter-group difference in any item concerning vital signs (N = 4), physical performance (N = 18), respiratory function (N = 27), quality of life (N = 21) and laboratory tests (N = 15). Arthralgia was significantly lower in the helmet group (16% vs. 55%, p = 0.002). Fifty-two percent of patients in helmet group vs. 63% of patients in high-flow group had diffusing capacity of the lungs for carbon monoxide < 80% of predicted (p = 0.44); 13% vs. 22% had forced vital capacity < 80% of predicted (p = 0.51). Both groups reported similar degree of pain (p = 0.81) and anxiety (p = 0.81) at the EQ-5D-5L test; the EQ-VAS score was similar in the two groups (p = 0.27). Compared to patients who successfully avoided invasive mechanical ventilation (54/71, 76%), intubated patients (17/71, 24%) had significantly worse pulmonary function (median diffusing capacity of the lungs for carbon monoxide 66% [Interquartile range: 47–77] of predicted vs. 80% [71–88], p = 0.005) and decreased quality of life (EQ-VAS: 70 [53–70] vs. 80 [70–83], p = 0.01).ConclusionsIn patients with COVID-19 hypoxemic respiratory failure, treatment with helmet NIV or high-flow oxygen yielded similar quality of life and functional outcome at 6 months. The need for invasive mechanical ventilation was associated with worse outcomes. These data indicate that helmet NIV, as applied in the HENIVOT trial, can be safely used in hypoxemic patients.Trial registration Registered on clinicaltrials.gov NCT04502576 on August 6, 2020

【 授权许可】

CC BY   
© The Author(s) 2023

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