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Author's response to “Continuous positive airway pressure helmet in patients with ARDS due to COVID-19 pneumonia: Insights about a therapy monitoring protocol”

Published:March 24, 2022DOI:https://doi.org/10.1016/j.aucc.2022.03.008
      Dear Sir,
      Thank you for your interest in our study,
      • Privitera D.
      • Capsoni N.
      • Mazzone A.
      • Airoldi C.
      • Angaroni L.
      • Pierotti F.
      • et al.
      Nursing evaluation during treatment with helmet continuous positive airway pressure in patients with respiratory failure due to COVID-19 pneumonia: a case series.
      and we are grateful for the opportunity to reply to your comments.
      We are used to personalising the therapy
      • Privitera D.
      • Angaroni L.
      • Capsoni N.
      • Forni E.
      • Pierotti F.
      • Vincenti F.
      • et al.
      Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department.
      by monitoring the respiratory rate (RR) and oxygen saturation and their response to helmet continuous positive airway pressure (H-CPAP) in patients with respiratory failure due to interstitial pneumonia due to COVID-19 because these are the two best independent parameters in noninvasive modality.
      • Brambilla A.M.
      • Aliberti S.
      • Prina E.
      • Nicoli F.
      • Del Forno M.
      • Nava S.
      • et al.
      Helmet CPAP vs. oxygen therapy in severe hypoxemic respiratory failure due to pneumonia.
      Furthermore, many patients with COVID-19 do not complain of dyspnoea in spite of a marked increase in the RR.
      • Di Domenico S.L.
      • Coen D.
      • Bergamaschi M.
      • Albertini V.
      • Ghezzi L.
      • Cazzaniga M.M.
      • et al.
      Clinical characteristics and respiratory support of 310 COVID-19 patients, diagnosed at the emergency room: a single-center retrospective study.
      We agree with your reflection: fever and discomfort can change the RR. For this reason, during nursing monitoring, body temperature, SpO2, RR, PEEP, and FiO2 were recorded before the H-CPAP trial was started every 30 min until the end of the trial.
      We did not analyse the patients’ compliance and comfort. These were not endpoints for us. The aim of our case series study was to describe the clinical characteristics of patients presenting to the emergency department with acute respiratory failure due to COVID-19–related pneumonia undergoing treatment with H-CPAP with a strict nursing evaluation and monitoring.
      However, during the first 2 h of the H-CPAP trial, we administered morphine in patients who referred to anxiety and discomfort.
      We did not analyse the causes of helmet failure as an interface. However, in studies comparing the effectiveness of facemasks, skin lesions are the main complications of noninvasive ventilation delivered,
      • Pisani L.
      • Carlucci A.
      • Nava S.
      Interfaces for noninvasive mechanical ventilation: technical aspects and efficiency.
      whereas with helmet, this problem could be avoided since there is no direct contact between the helmet and the patient's face. On the other hand, noise needs to be reduced to increase patients' comfort and tolerance to the respiratory support.
      • Cavaliere F.
      • Conti G.
      • Costa R.
      • Proietti R.
      • Sciuto A.
      • Masieri S.
      Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask.
      We suggest that the percent of interface failure in our study is comparable to the one in the previous studies.
      • Aliberti S.
      • Radovanovic D.
      • Billi F.
      • Sotgiu G.
      • Costanzo M.
      • Pilocane T.
      • et al.
      Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study.
      As regard your last question, according to the literature,
      • Tang N.
      • Bai H.
      • Chen X.
      • Gong J.
      • Li D.
      • Sun Z.
      Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy.
      all our patients were prophylaxed with low-molecular-weight heparin.

      CRediT authorship contribution statement

      Daniele Privitera, Nicolò Capsoni, Andrea Bellone: Conceptualisation, Visualisation, Supervision, Writing-Reviewing and Editing.

      References

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        • Pierotti F.
        • et al.
        Nursing evaluation during treatment with helmet continuous positive airway pressure in patients with respiratory failure due to COVID-19 pneumonia: a case series.
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