Helmet continuous positive airway pressure and prone positioning: A proposal for an early management of COVID-19 patients

In late December 2019, clusters of patients with interstitial pneumonia of unknown cause were reported by some local health facilities in Wuhan (China). The Chinese Centre for Disease Control conducted an epidemiologic and etiologic investigation, leading to the identification of a novel coronavirus (SARS-CoV-2).1, 2 On March 11th, the World Health Organization (WHO) declared the novel coronavirus disease (COVID-19) a pandemic. In the area of Wuhan, COVID-19 mainly affected male patients (around 60%), with a median age of about 50 years; 40% of patients developed Acute Respiratory Distress Syndrome (ARDS) 5% requiring intensive care. The mortality rate was around 2%.3, 4 However, Grasselli et al. found that the mortality was 26% in ICU. The death rate was higher among those who were older.5. The hypothesis is that in case of a pandemic, selected COVID-19 patients may benefit from the combination of early hCPAP and prone position sessions, in order to reduce the need for intubation and invasive mechanical ventilation, “buying time” for the disease to heal.