Preditores de sucesso de pacientes em uso do ELMO-CPAP com sedação leve, na prevenção de intubação endotraqueal e mortalidade em pacientes com COVID-19 grave

Abstract

The CPAP (continuous positive airway pressure) with helmet has been applied to patients with acute hypoxemic respiratory failure (AHRF) caused by COVID-19. Predictors of success and mortality are still under debate. The main objective was to identify predictors of success in the application of a new device and protocol, the ELMO-cpap with mild sedation, in preventing orotracheal intubation (OTI) and mortality. A retrospective cohort study examined the intubation and mortality rates of patients with COVID-19-induced AHRF treated with ELMO-cpap and mild sedation with dexmedetomidine outside the intensive care unit (ICU). Demographic, clinical, imaging, and laboratory data, as well as the duration and response to ELMO-cpap sessions, were analyzed to identify predictors of the primary outcomes. Success was defined as no need for OTI. One hundred and eighty patients were included in the study. 72.8% of the patients were not intubated after using ELMO-cpap. Multiple logistic regression showed that the success group was younger, remained continuously on ELMO-cpap for more than 32 hours during the first session, had less than 75% lung involvement in chest tomography, and had ROX index values above 5.2. The mortality rate was 18.9%, and those in the failure group had a higher rate compared to the success group. Risk factors were age and lung involvement greater than 75% in chest tomography. A first ELMO-cpap session lasting more than 32 hours was associated with reduced mortality. In conclusion the ELMO-cpap with mild sedation resulted in over 70% of COVID-19 patients with AHRF not progressing to OTI therapy. Younger age, ROX index > 5.28 at the second hour of therapy, lung impairment on high-resolution computed tomography scan less than 75% on hospital admission, and particularly a first ELMO-CPAP session lasting > 32 hours can identify those patients with better short-term outcomes and prognosis.