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0 0.5 1 1.5 2+ Ventilation 40% Improvement Relative Risk HCQ for COVID-19  Capsoni et al.  LATE TREATMENT Is late treatment with HCQ beneficial for COVID-19? Retrospective 52 patients in Italy Lower ventilation with HCQ (not stat. sig., p=0.3) Capsoni et al., Research Square, December 2020 Favors HCQ Favors control

CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department

Capsoni et al., Research Square, doi:10.21203/
Dec 2020  
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HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
*, now known with p < 0.00000000001 from 421 studies, recognized in 42 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
3,800+ studies for 60+ treatments.
Small 52 patient retrospective study of patients with acute respiratory failure showing lower rates of intubation with HCQ.
risk of mechanical ventilation, 40.0% lower, RR 0.60, p = 0.30, treatment 12 of 40 (30.0%), control 6 of 12 (50.0%), NNT 5.0.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Capsoni et al., 1 Dec 2020, retrospective, Italy, preprint, 13 authors, average treatment delay 7.0 days.
This PaperHCQAll
CPAP Treatment In COVID-19 Patients: A Retrospective Observational Study In The Emergency Department
Nicolò Capsoni, Daniele Privitera, Annamaria Mazzone, Chiara Airoldi, Valentina Albertini, Laura Angaroni, Marta Bergamaschi, Alberto Dal Molin, Elisa Forni, Federico Pierotti, Eugenia Rocca, Fabrizio Vincenti, Andrea Bellone
Background During COVID-19 outbreak, with the increasing number of patients presenting with acute respiratory failure (ARF), a large use of non-invasive positive pressure ventilation (NIPPV) was done in the Emergency Departments (EDs) and medical wards despite the lack of recommendations. We aimed to assess the use of continuous positive airway pressure (CPAP) in the ED. The primary endpoint was the rate of CPAP failure and the need of endotracheal intubation (ETI). Secondary endpoints were in-hospital mortality and intensive care unit (ICU) and in-hospital length of stay. Methods A retrospective observational study enrolling adult patients admitted to the ED of Niguarda Hospital, Milan, Italy, with ARF due to COVID-19 pneumonia from March 18th to April 18th 2020, was conducted. Only patients who strictly followed a local CPAP protocol were enrolled. Results A total of 52 patients were included in this study. 38 patients (73%) were judged eligible for ETI. 18 (34.6%) were intubated. 16 (30.8%) patients died: 7 (38.9%) and 9 (26.5%) in the ETI and non-ETI group respectively. The median hospital length of stay was different in ETI and non-ETI patients: 26 days [IQR 16-37] vs 15 days [IQR 9-17] (p = 0.005). The median invasive mechanical ventilation time was 11 days [IQR 7-21] with an ICU length of stay of 14.5 days [IQR 10-28]. During the CPAP trial, variations between ETI and non-ETI patients over time were found for positive end-expiratory pressure (PEEP) (p = 0.003) and respiratory rate (RR) (p = 0.059). Conclusionss A short closed monitored CPAP trial could be considered for ARF due to COVID-19 pneumonia before considering ETI. A progressive PEEP titration should target patient's RR reduction. More studies are needed to evaluate the e cacy and predictors of failure of CPAP and NIPPV in patients with ARF due to COVID-19 pneumonia.
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Respiratory Rate, Peep, con dence intervals obtained performing mixed models, which take into account for repeated measures within subjects
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Late treatment
is less effective
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