In-hospital utilization of pre-hospital device for CPAP to manage acute respiratory failure in CoViD-19 pneumonia: findings from a single center

ABSTRACT

Background: Since February 2020, CoViD-19 spread in Italy. Acute respiratory failure (ARF) was the most relevant clinical presentation, often requiring invasive and non-invasive ventilation. We report the management of ARF in in-patients using Easy Vent Mask (EVM) system for C-PAP, a device registered for prehospital use. Methods: In this retrospective study, we included all patients admitted to Emergency Medicine Unit from March 2 to April 25, 2020 with ARF secondary to CoViD-19 pneumonia and treated with EVM system. Our aim was to evaluate the efficacy and tolerability of in-hospital use of EVM system. All demographic, clinical and treatment data were recorded. Results: Thirty patients affected by mild/moderate CoViD-19 pneumonia having PaO2/FiO2(P/F) ratio between 100 and 200 were treated with EVM system for C-PAP, of them 25(83%) were discharged and 5(17%) died in hospital. The system was well tolerated with a mean time of use of 13 consecutive days. Five patients were transferred to ICU due to failure of C-PAP treatment, of whom 3 died. Two patients died in our ward for worsening of clinical conditions. Pressure skin lesions and hypercapnia were recorded as adverse events in 24 and 2 patients respectively. Moreover, our finding showed a higher reduction of P/F value and a longer time from admission to C-PAP initiation in non-survivors, compared to survivor patients. Conclusions: EVM system for C-PAP seemed to be well tolerated and may represent an alternative to ventilators in in-hospital treatment of CoViD-19 mild/moderate pneumonia, but dedicated studies are needed.