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Using vital signs measurements to identify patients with COVID-19 who require early continuous positive airway
Chiara Colombo1, Andrea Albani1, Francesco Banfi1
1emergency department, ASST Fatebenefratelli Sacco, Milan, Italy.
Insights
This study identified key vital signs in the emergency department to predict which COVID-19 patients need early continuous positive airway pressure (CPAP) for severe pneumonia. These findings can help streamline treatment for critical respiratory distress.
Area of Science:
- Emergency Medicine
- Pulmonology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) can cause severe pneumonia and acute respiratory distress syndrome.
- Early initiation of continuous positive airway pressure (CPAP) is crucial for managing COVID-19-related respiratory failure.
- Rapid patient evaluation during triage is essential for timely CPAP treatment.
Purpose of the Study:
- To identify COVID-19 patients in the emergency department (ED) requiring early CPAP.
- Utilize vital signs measured during triage for early identification.
- Develop a data-driven approach for optimizing CPAP allocation.
Main Methods:
- Retrospective, observational, single-centre cohort study.
- Involved 601 COVID-19 patients admitted to the ED.
- Compared vital signs of patients who did and did not require CPAP.
Main Results:
- 20% of patients (120/601) required CPAP.
- Predictive factors for early CPAP included male sex, age (median 68 years), low oxygen saturation (92%), elevated temperature (≥38°C), high respiratory rate (26 breaths/min), and pre-hospital oxygen therapy.
- Significant differences in respiratory rates were observed between CPAP subgroups based on pre-hospital oxygen use.
Conclusions:
- Established characteristics of COVID-19 patients needing early CPAP.
- Devised a triage flowchart using oxygen saturation, respiratory rate, and pre-hospital oxygen therapy.
- Recommended prospective validation of the flowchart for clinical decision-making.
Background:
The coronavirus disease 2019 (COVID-19) can result in severe pneumonia, leading to acute respiratory distress syndrome, which are treated using continuous positive airway pressure (CPAP). Patients must be evaluated quickly to commence early CPAP if required.
Aim:
To identify patients with COVID-19 in the emergency department (ED) who require early CPAP, using vital signs measurements during triage.
Method:
This was a retrospective, observational, single-centre cohort study of patients with COVID-19 admitted to the ED of a university hospital in Lombardy, Italy, between 21 February 2020 and 30 April 2020. These patients were divided into two groups: those who required CPAP and those did not require CPAP. Recordings of their vital signs were retrieved from triage medical records. The vital signs values recorded in the two groups on their arrival at the ED were compared.
Results:
Of 601 patients, 120 (20%) required CPAP. It was identified that the typical characteristics of patients requiring early CPAP were: male (P=.013) with a median age of 68 years (P=.000), oxygen saturation of 92% (P=.000), temperature ≥38°C (P=.008), respiratory rate of 26 breaths per minute (P=.000) and had received pre-hospital oxygen therapy before arriving at the ED (P=.000). The CPAP group was divided into two subgroups: patients who had received pre-hospital oxygen therapy and those who had not. The median respiratory rate values between the two subgroups presented a statistically significant difference (P=.004).
Conclusion:
This study identified the characteristics of a typical patient with COVID-19 who requires early CPAP. Based on the results, the authors have devised a triage flow chart that uses selected vital signs measurements (oxygen saturation, respiratory rate and receipt of pre-hospital oxygen therapy) to identify patients requiring early CPAP. This flow chart should be trialled in a prospective study before it is used to inform clinical decision-making.
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