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Available online 27 March 2024
Effectiveness of Helmet-CPAP in mild to moderate coronavirus type 2 hypoxemia: An observational study
Efectividad del Helmet-CPAP en hipoxemia leve a moderada por coronavirus tipo 2: Un estudio observacional
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Aurio Fajardo-Campoverdia,
,1
, Juan José Orellana-Cáceresb, Vicente Fernándezc, Felipe Pobletec, Priscila Reyesc, Kevin Rebolledoc
a Universidad de la Frontera, Critical Care Unit, Hospital Biprovincial Quillota–Petorca, Chile
b Centro de Investigación y Gestión para la Salud Basada en Evidencia (CIGES), Facultad de Medicina, Universidad de la Frontera, Temuco, Chile
c Hospital de Quilpué, Chile
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Received 09 December 2023. Accepted 28 February 2024
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Table 1. Description and distribution of variables according to type of support (baseline).
Table 2. Sequential description of ventilatory and gas exchange variables according to type of support.
Table 3. Multivariate analysis for the outcomes.
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Abstract
Objective

To determine the relative effectiveness of Helmet-CPAP (H_CPAP) with respect to high-flow nasal cannula oxygen therapy (HFNO) in avoiding greater need for intubation or mortality in a medium complexity hospital in Chile during the year 2021.

Design

Cohort analytical study, single center.

Setting

Units other than intensive care units.

Patients

Records of adults with mild to moderate hypoxemia due to coronavirus type 2.

Interventions

None.

Main variables of interest

Need for intubation or mortality.

Results

159 patients were included in the study, with a ratio by support of 2:10 (H_CPAP:HFNO). The 46.5% were women, with no significant differences by sex according to support (p = 0.99, Fisher test). The APACHE II score, for HFNO, had a median of 10.5, 3.5 units higher than H_CPAP (p < 0.01, Wilcoxon rank sum). The risk of intubation in HFNO was 42.1% and in H_CPAP 3.8%, with a significant risk reduction of 91% (95% CI: 36.9%–98.7%; p < 0.01). APACHE II does not modify or confound the support and intubation relationship (p > 0.2, binomial regression); however, it does confound the support and mortality relationship (p = 0.82, RR homogeneity test). Despite a 79.1% reduction in mortality risk with H_CPAP, this reduction was not statistically significant (p = 0.11, binomial regression).

Conclusions

The use of Helmet CPAP, when compared to HFNO, was an effective therapeutic ventilatory support strategy to reduce the risk of intubation in patients with mild to moderate hypoxemia caused by coronavirus type 2 in inpatient units other than intensive care. The limitations associated with the difference in size, age and severity between the arms could generate bias.

Keywords:
Helmet
CPAP
Covid 19
Coronavirus
PEEP
Acute Respiratory Distress Syndrome (ARDS)
Resumen
Objetivo

Determinar la efectividad relativa del Helmet-CPAP (H_CPAP) respecto a la oxigenoterapia con cánula nasal de alto flujo (CNAF) para evitar mayor necesidad de intubación o mortalidad en un hospital de mediana complejidad en Chile durante el año 2021.

Diseño

Estudio analítico de cohorte, en centro único.

Ámbito

Unidades clínicas que no sean de cuidados intensivos.

Pacientes

Registros de adultos con hipoxemia leve a moderada debida a coronavirus tipo 2.

Intervenciones

Ninguna.

Principales variables de interés

Necesidad de intubación o mortalidad.

Resultados

Se incluyeron 159 pacientes en el estudio, con una razón por soporte de 2:10 (H_CPAP:HFNO). El 46,5% fueron mujeres, sin diferencias significativas por sexo según soporte (p = 0,99, test de Fisher). La puntuación APACHE II, para CNAF, tuvo una mediana de 10,5, 3,5 unidades mayor que H_CPAP (p < 0,01, Wilcoxon rank sum). El riesgo de intubación en CNAF fue del 42,1% y en H_CPAP del 3,8%, con una reducción significativa del riesgo del 91% (IC 95%: 36,9% a 98,7%; p < 0,01). APACHE II no modifica ni confunde la relación soporte e intubación (p > 0,2, regresión binomial); sin embargo, sí confunde la relación soporte y mortalidad (p = 0,82, test de homogeneidad RR). A pesar de que se observa un 79,1% de reducción del riesgo de mortalidad con H_CPAP, esta reducción no fue estadísticamente significativa (p = 0,11, regresión binomial).

Conclusiones

El uso de Helmet CPAP, al compararse con CNAF, fue una estrategia de soporte ventilatorio terapéutico eficaz para reducir el riesgo de intubación en pacientes con hipoxemia leve a moderada causada por coronavirus tipo 2 en unidades de hospitalización distintas de cuidados intensivos. Las limitaciones asociadas a la diferencia de tamaño, edad y gravedad entre los brazos de estudio podrían generar sesgo.

Palabras clave:
Helmet
CPAP
Covid 19
Coronavirus
PEEP
Síndrome de distrés respiratorio agudo (SDRA)

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