CPAP delivered via a helmet interface in lightly sedated patients with moderate to severe ARDS: predictors of success outside the ICU

J Bras Pneumol. 2024 Dec 6;50(5):e20240299. doi: 10.36416/1806-3756/e20240299. eCollection 2024.

Abstract

Objective: This study aimed to describe the outcomes and explore predictors of intubation and mortality in patients with ARDS due to COVID-19 treated with CPAP delivered via a helmet interface and light sedation.

Methods: This was a retrospective cohort study involving patients with COVID-19-related ARDS who received CPAP using a helmet developed in Brazil (ELMO™), associated with a light sedation protocol in a pulmonology ward. Demographic, clinical, imaging, and laboratory data, as well as the duration and response to the ELMO-CPAP sessions, were analyzed.

Results: The sample comprised 180 patients. The intubation avoidance rate was 72.8%. The lack of necessity for intubation was positively correlated with younger age, > 24-h continuous HELMET-CPAP use in the first session, < 75% pulmonary involvement on CT, and ROX index > 4.88 in the second hour. The overall in-hospital mortality rate was 18.9%, whereas those in the nonintubated and intubated groups were 3.0% and 61.2%, respectively. Advanced age increased the mortality risk by 2.8 times, escalating to 13 times post-intubation.

Conclusions: ELMO-CPAP with light sedation in a pulmonology ward was successful in > 70% of patients with moderate to severe ARDS due to COVID-19. Younger age, pulmonary involvement, ROX index, and prolonged first Helmet-CPAP session duration were associated with no need for intubation. Older age and intubation are associated with mortality.

MeSH terms

  • Adult
  • Aged
  • Brazil
  • COVID-19* / complications
  • Conscious Sedation / methods
  • Continuous Positive Airway Pressure* / instrumentation
  • Continuous Positive Airway Pressure* / methods
  • Female
  • Head Protective Devices
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Intubation, Intratracheal / instrumentation
  • Intubation, Intratracheal / methods
  • Male
  • Middle Aged
  • Respiratory Distress Syndrome* / mortality
  • Respiratory Distress Syndrome* / therapy
  • Retrospective Studies
  • SARS-CoV-2
  • Severity of Illness Index
  • Treatment Outcome