TY - JOUR T1 - Outcomes of COVID-19 patients treated with continuous positive airway pressure outside ICU JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00541-2020 SP - 00541-2020 AU - Rosanna Vaschetto AU - Francesco Barone-Adesi AU - Fabrizio Racca AU - Claudio Pissaia AU - Carlo Maestrone AU - Davide Colombo AU - Carlo Olivieri AU - Nello De Vita AU - Erminio Santangelo AU - Lorenza Scotti AU - Luigi Castello AU - Tiziana Cena AU - Martina Taverna AU - Luca Grillenzoni AU - Maria Adele Moschella AU - Gianluca Airoldi AU - Silvio Borrè AU - Francesco Mojoli AU - Francesco Della Corte AU - Paolo Navalesi AU - Gianmaria Cammarota AU - Marta Baggiani AU - Sara Baino AU - Piero Balbo AU - Simona Bazzano AU - Valeria Bonato AU - Sara Carbonati AU - Federico Crimaldi AU - Veronica Daffara AU - Luca De Col AU - Matteo Maestrone AU - Mario Malerba AU - Federica Moroni AU - Raffaella Perucca AU - Mario Pirisi AU - Valentina Rondi AU - Daniela Rosalba AU - Letizia Vanni AU - Francesca Vigone Y1 - 2020/01/01 UR - http://openres.ersjournals.com/content/early/2020/10/22/23120541.00541-2020.abstract N2 - Aim We aim at characterising a large population of Coronavirus 19 (COVID-19) patients with moderate-to-severe hypoxemic acute respiratory failure (ARF) receiving CPAP outside intensive care unit (ICU), and ascertaining whether the duration of CPAP application increased the risk of mortality for patients requiring intubation.Methods In this retrospective, multicentre cohort study, we included COVID-19 adult patients, treated with CPAP outside ICU for hypoxemic ARF from March 1st to April 15th, 2020. We collected demographic and clinical data, including CPAP therapeutic goal, hospital length of stay (LOS), and 60-day in-hospital mortality.Results The study includes 537 patients with a median age of 69 (IQR, 60–76) years. Males were 391 (73%). According to predefined CPAP therapeutic goal, 397 (74%) patients were included in full treatment subgroup, and 140 (26%) in the do-not intubate (DNI) subgroup. Median CPAP duration was 4 (IQR, 1–8) days, while hospital LOS 16 (IQR, 9–27) days. Sixty-day in-hospital mortality was overall 34% (95%CI, 0.304–0.384), and 21% (95%CI, 0.169–0.249) and 73% (95%CI, 0.648–0.787) for full treatment and DNI subgroups, respectively. In the full treatment subgroup, in-hospital mortality was 42% (95%CI, 0.345–0.488) for 180 (45%) CPAP failures requiring intubation, while 2% (95%CI, 0.008–0.035) for the remaining 217 (55%) patients who succeeded. Delaying intubation was associated with increased mortality [HR, 1.093 (95%CI, 1.010–1.184)].Conclusions We described a large population of COVID-19 patients treated with CPAP outside ICU. Intubation delay represents a risk factor for mortality. Further investigation is needed for early identification of CPAP failures.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Rosanna VaschettoConflict of interest: nothing to declareConflict of interest: F. Racca reports personal fees from Philips Respironics outside the submitted work.Conflict of interest: Claudio PissaiaConflict of interest: Carlo MaestroneConflict of interest: D. Colombo reports personal fees for lectures from Nestlé Healthcare Nutrition outside the submitted work.Conflict of interest: Dr. Olivieri has a patent 102016000114357 with royalties paid to Intersurgical SpA.Conflict of interest: Nello De VitaConflict of interest: Erminio SantangeloConflict of interest: Lorenza ScottiConflict of interest: Luigi CastelloConflict of interest: Tiziana CenaConflict of interest: Martina TavernaConflict of interest: Luca GrillenzoniConflict of interest: Maria Adele MoschellaConflict of interest: Gianluca AiroldiConflict of interest: Silvio BorrèConflict of interest: F. Mojoli reports personal fees for lecturing from GE Healthcare, Medical and Seda Spa, outside the submitted work; and a consultancy agreement between University of Pavia and Hamilton Medical.Conflict of interest: Francesco Della CorteConflict of interest: P. Navalesi reports personal fees from Intersurgical SpA, Resmed, Philips, Novartis, MSD, Getinge and Orion Pharma, and research equipment (institutional) from Draeger, outside the submitted work; in addition, he has a patent 102020000008305 pending to Università di Padova (no profit) and a patent 102016000114357 with royalties paid to Intersurgical SpA.Conflict of interest: Gianmaria CammarotaConflict of interest: Marta BaggianiConflict of interest: Sara BainoConflict of interest: Piero BalboConflict of interest: Simona BazzanoConflict of interest: Valeria BonatoConflict of interest: Sara CarbonatiConflict of interest: Federico CrimaldiConflict of interest: Veronica DaffaraConflict of interest: Luca De ColConflict of interest: Matteo MaestroneConflict of interest: Mario MalerbaConflict of interest: Federica MoroniConflict of interest: Raffaella PeruccaConflict of interest: Mario PirisiConflict of interest: Valentina RondiConflict of interest: Daniela RosalbaConflict of interest: Letizia VanniConflict of interest: Francesca Vigone ER -