Background

During the COVID-19 outbreak, a very high number of infected patients developed pneumonia and many of them complicated with acute respiratory distress syndrome. The optimal management of respiratory failure and the role of lung ultrasound imaging in the evaluation of efficacy of treatment are unknown.

Methods

In March 2020 we treated 18 patients with mild and moderate ARDS secondary to SARS-CoV-2 with non-invasive continuous positive airway pressure therapy (NI-CPAP). All patients underwent lung ultrasound imaging to verify the entity of lung recruitment after NI-CPAP initiation.

Results

After one hour of treatment we observed a significant improvement in PaO2/FiO2 ratio in 10 patients. Notably, only 50% of them reached an effective improvement in lung aeration detectable with lung ultrasound. In the other 50% or patients the improvement in PaO2/FiO2 might be related to blood redistribution and reverse of hypoxic vasoconstriction.

Conclusion

NI- CPAP is a valid therapeutic option in mild and moderate ARDS secondary SARS-CoV-2. Lung recruitment detected by means of lung ultrasound is a relevant but not the exclusive mechanism that underlies the therapeutic efficacy of NI-CPAP in this clinical setting.

中文翻译：

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无创 CPAP 治疗继发于 SARS-CoV-2 的轻度和中度 ARDS。

 背景

在 COVID-19 爆发期间，大量感染患者出现肺炎，其中许多人并发急性呼吸窘迫综合征。呼吸衰竭的最佳治疗方法以及肺部超声成像在评估治疗效果中的作用尚不清楚。

 方法

2020 年 3 月，我们采用无创持续气道正压通气治疗 (NI-CPAP) 治疗了 18 名继发于 SARS-CoV-2 的轻度和中度 ARDS 患者。所有患者均接受肺部超声成像，以验证 NI-CPAP 启动后肺复张的实体。

 结果

经过一小时的治疗后，我们观察到 10 名患者的 PaO2/FiO2 比率显着改善。值得注意的是，只有 50% 的人达到了肺部超声可检测到的肺通气的有效改善。在另外 50% 或 50% 的患者中，PaO2/FiO2 的改善可能与血液重新分布和缺氧血管收缩的逆转有关。

 结论

NI-CPAP 是治疗轻度和中度 ARDS 继发 SARS-CoV-2 的有效治疗选择。通过肺部超声检测的肺复张是一种相关但不是唯一的机制，它是 NI-CPAP 在此临床环境中治疗效果的基础。