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SARS-CoV-2 pneumonia succesfully treated with cpap and cycles of tripod position: a case report.
Rauseo, Michela; Mirabella, Lucia; Caporusso, Rosa Roberta; Cantatore, Leonarda Pia; Perrini, Marco Paolo; Vetuschi, Paolo; La Bella, Daniela; Tullo, Livio; Cinnella, Gilda.
  • Rauseo M; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Mirabella L; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Caporusso RR; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Cantatore LP; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Perrini MP; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Vetuschi P; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • La Bella D; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Tullo L; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy.
  • Cinnella G; Department of Anesthesia and Intensive Care Unit, Università degli Studi di Foggia, Azienda Ospedaliero Universitaria "Ospedali Riuniti di Foggia", Viale Pinto, 1, 71122, Foggia, Italy. gilda.cinnella@unifg.i.
BMC Anesthesiol ; 21(1): 9, 2021 01 08.
Article in English | MEDLINE | ID: covidwho-1015835
Semantic information from SemMedBD (by NLM)
1. Hypoxemic Respiratory Failure COEXISTS_WITH Coronavirus Infections
Subject
Hypoxemic Respiratory Failure
Predicate
COEXISTS_WITH
Object
Coronavirus Infections
2. Compliance PROCESS_OF Patients
Subject
Compliance
Predicate
PROCESS_OF
Object
Patients
3. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
4. Hemodynamics PROCESS_OF Patients
Subject
Hemodynamics
Predicate
PROCESS_OF
Object
Patients
5. Respiratory Mechanics PROCESS_OF Patients
Subject
Respiratory Mechanics
Predicate
PROCESS_OF
Object
Patients
6. Prone positioning COEXISTS_WITH Continuous Positive Airway Pressure
Subject
Prone positioning
Predicate
COEXISTS_WITH
Object
Continuous Positive Airway Pressure
7. Arterial Blood Gases PROCESS_OF Patients
Subject
Arterial Blood Gases
Predicate
PROCESS_OF
Object
Patients
8. Tripod position PROCESS_OF Patients
Subject
Tripod position
Predicate
PROCESS_OF
Object
Patients
9. Hypoxemic Respiratory Failure COEXISTS_WITH Coronavirus Infections
Subject
Hypoxemic Respiratory Failure
Predicate
COEXISTS_WITH
Object
Coronavirus Infections
10. Compliance PROCESS_OF Patients
Subject
Compliance
Predicate
PROCESS_OF
Object
Patients
11. Pneumonia PROCESS_OF Patients
Subject
Pneumonia
Predicate
PROCESS_OF
Object
Patients
12. Hemodynamics PROCESS_OF Patients
Subject
Hemodynamics
Predicate
PROCESS_OF
Object
Patients
13. Respiratory Mechanics PROCESS_OF Patients
Subject
Respiratory Mechanics
Predicate
PROCESS_OF
Object
Patients
14. Prone positioning COEXISTS_WITH Continuous Positive Airway Pressure
Subject
Prone positioning
Predicate
COEXISTS_WITH
Object
Continuous Positive Airway Pressure
15. Arterial Blood Gases PROCESS_OF Patients
Subject
Arterial Blood Gases
Predicate
PROCESS_OF
Object
Patients
16. Tripod position PROCESS_OF Patients
Subject
Tripod position
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

Pneumonia induced by 2019 Coronavirus (COVID-19) is characterized by hypoxemic respiratory failure that may present with a broad spectrum of clinical phenotypes. At the beginning, patients may have normal lung compliance and be responsive to noninvasive ventilatory support, such as CPAP. However, the transition to more severe respiratory failure - Severe Acute Respiratory Syndrome (SARS-CoV-2), necessitating invasive ventilation is often abrupt and characterized by a severe V/Q mismatch that require cycles of prone positioning. The aim of this case is to report the effect on gas exchange, respiratory mechanics and hemodynamics of tripod (or orthopneic sitting position) used as an alternative to prone position in a patient with mild SARS-CoV-2 pneumonia ventilated with helmet CPAP. CASE PRESENTATION A 77-year-old awake and collaborating male patient with mild SARS-CoV-2 pneumonia and ventilated with Helmet CPAP, showed sudden worsening of gas exchange without dyspnea. After an unsuccessful attempt of prone positioning, we alternated three-hours cycles of semi-recumbent and tripod position, still keeping him in CPAP. Arterial blood gases (PaO2/FiO2, PaO2, SaO2, PaCO2 and A/a gradient), respiratory (VE, VT, RR) and hemodynamic parameters (HR, MAP) were collected in the supine and tripod position. Cycles of tripod position were continued for 3 days. The patient had a clinically important improvement in arterial blood gases and respiratory parameters, with stable hemodynamic and was successfully weaned and discharged to ward 10 days after pneumonia onset.

CONCLUSIONS:

Tripod position during Helmet CPAP can be applied safely in patients with mild SARS-CoV-2 pneumonia, with improvement of oxygenation and V/Q matching, thus reducing the need for intubation.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Mechanics / Continuous Positive Airway Pressure / Patient Positioning / SARS-CoV-2 / COVID-19 Type of study: Case report Limits: Aged / Humans / Male Language: English Journal: BMC Anesthesiol Year: 2021 Document Type: Article Affiliation country: S12871-020-01221-5

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Mechanics / Continuous Positive Airway Pressure / Patient Positioning / SARS-CoV-2 / COVID-19 Type of study: Case report Limits: Aged / Humans / Male Language: English Journal: BMC Anesthesiol Year: 2021 Document Type: Article Affiliation country: S12871-020-01221-5