Continuous positive airway pressure and pronation outside the intensive care unit in COVID 19 ARDS.

Ramirez, Giuseppe A; Bozzolo, Enrica P; Castelli, Elena; Marinosci, Alessandro; Angelillo, Piera; Damanti, Sarah; Scotti, Raffaella; Gobbi, Agnese; Centurioni, Clarissa; Di Scala, Flavia; Morgillo, Anna; Castagna, Antonella; Conte, Caterina; Assanelli, Andrea; De Cobelli, Francesco; Calcaterra, Barbara; Cabrini, Luca; Carcó, Francesco; Turi, Stefano; Silvani, Paolo; Dagna, Lorenzo; Zangrillo, Alberto; Landoni, Giovanni; Tresoldi, Moreno

BACKGROUND The efficacy and safety of continuous positive airway pressure and respiratory physiotherapy outside the ntensive care unit during a pandemic. METHODS In this cohort study performed in February-May 2020 in a large teaching hospital in Milan, COVID-19 patients with adult respiratory distress syndrome receiving continuous positive airway pressure (positive end-expiratory pressure = 10 cm H2O, FiO2 = 0.6, daily treatment duration: 4x3hcycles) and respiratory physiotherapy including pronation outside the intensive care unit were followed up. RESULTS Of 90 ARDS patients treated with continuous positive airway pressure (45/90, 50% pronated at least once) outside the intensive care unit and with a median (interquartile) follow up of 37 (11-46) days, 45 (50%) were discharged at home, 28 (31%) were still hospitalized, and 17 (19%) died. Continuous positive airway pressure failure was recorded for 35 (39%) patients. Patient mobilization was associated with reduced failure rates (p=0.033). No safety issues were observed. CONCLUSIONS Continuous positive airway pressure with patient mobilization (including pronation) was effective and safe in patients with ARDS due to COVID-19 managed outside the intensive care unit setting during the pandemic.