{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T06:44:08Z","timestamp":1777185848158,"version":"3.51.4"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T00:00:00Z","timestamp":1642723200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Canadian Respiratory Journal"],"published-print":{"date-parts":[[2022,1,21]]},"abstract":"<jats:p>Background. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory indexes as possible predictors of CPAP failure in ARF due to COVID-19. Methods. This was a multicenter, prospective, observational, and cohort study conducted in the respiratory units of three University hospitals in Milan and in a secondary care hospital in Codogno (Italy), on consecutive adult patients with ARF due to COVID-19 pneumonia that underwent CPAP between March 2020 and March 2021. ETI transfer to the intensive care unit or death is defined CPAP failure. Predictors of CPAP failure were assessed before T0 and 1 hour after T1 CPAP initiation and included mROX index (ratio of PaO2\/FiO2 to respiratory rate), alveolar-to-arterial (A-a) O2 gradient, and the HACOR (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) score. Results. Three hundred and fifty four patients (mean age 64 years, 73% males) were included in the study; 136 (38.4%) satisfied criteria for CPAP failure. A-a O2 gradient, mROX, and HACOR scores were worse in patients who failed CPAP, both at T0 and T1 (<jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>&lt;<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula> for all parameters). The HACOR score was associated with CPAP failure (odds ratio\u2014OR\u2014for every unit increase in HACOR\u2009=\u20091.361; 95%CI: 1.103\u20131.680; <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.004<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>; AUROC\u2009=\u20090.742; <jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>). CPAP failure was best predicted by a threshold of 4.50 (sensitivity\u2009=\u200953% and specificity\u2009=\u200987%). Conclusions. The HACOR score may be a reliable and early predictor of CPAP failure in patients treated for ARF in COVID-19 pneumonia.<\/jats:p>","DOI":"10.1155\/2022\/1499690","type":"journal-article","created":{"date-parts":[[2022,1,22]],"date-time":"2022-01-22T04:05:13Z","timestamp":1642824313000},"page":"1-6","source":"Crossref","is-referenced-by-count":17,"title":["Predictors of Helmet CPAP Failure in COVID-19 Pneumonia: A Prospective, Multicenter, and Observational Cohort Study"],"prefix":"10.1155","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3462-8253","authenticated-orcid":true,"given":"Pierachille","family":"Santus","sequence":"first","affiliation":[{"name":"Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milano, Italy"},{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3084-4365","authenticated-orcid":true,"given":"Stefano","family":"Pini","sequence":"additional","affiliation":[{"name":"Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milano, Italy"},{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-7785","authenticated-orcid":true,"given":"Francesco","family":"Amati","sequence":"additional","affiliation":[{"name":"Respiratory Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Saad","sequence":"additional","affiliation":[{"name":"Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milano, Italy"},{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Gatti","sequence":"additional","affiliation":[{"name":"Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milano, Italy"},{"name":"Department of Biomedical and Clinical Sciences (DIBIC), Universit\u00e0 degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9672-3534","authenticated-orcid":true,"given":"Michele","family":"Mondoni","sequence":"additional","affiliation":[{"name":"Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy"},{"name":"Dipartimento di Scienze Della Salute, Universit\u00e0 degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Tursi","sequence":"additional","affiliation":[{"name":"UOS Pneumologia, Ospedale Civico di Codogno, ASST Lodi, Lodi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Rizzi","sequence":"additional","affiliation":[{"name":"Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-3930","authenticated-orcid":true,"given":"Davide Alberto","family":"Chiumello","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Della Salute, Universit\u00e0 degli Studi di Milano, Milano, Italy"},{"name":"Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milano, Italy"},{"name":"Coordinated Research Center on Respiratory Failure, Universit\u00e0 Degli Studi di Milano, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valter","family":"Monzani","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Department of Medicine, Acute Medical Unit, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2285-9970","authenticated-orcid":true,"given":"Francesco","family":"Blasi","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milano, Italy"},{"name":"Universit\u00e0 Degli Studi di Milano, Department of Pathophysiology and Transplantation, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0090-4531","authenticated-orcid":true,"given":"Stefano","family":"Aliberti","sequence":"additional","affiliation":[{"name":"Respiratory Unit, 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