Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19

Abstract

Aim Noninvasive ventilation (NIV) is known to reduce intubation in patients with acute hypoxemic respiratory failure (AHRF) [ 1 ]. We aimed to assess the outcomes of NIV application in COVID-19 patients with AHRF. Materials & methods In this retrospective cohort study, patients with confirmed diagnosis of COVID-19 and AHRF receiving NIV in general wards were recruited from two university-affiliated hospitals. Demographic, clinical, and laboratory data were recorded at admission. The failure of NIV was defined as intubation or death during the hospital stay. Results Between April 8 and June 10, 2020, 61 patients were enrolled into the final cohort. NIV was successful in 44 out of 61 patients (72.1%), 17 patients who failed NIV therapy were intubated, and among them 15 died. Overall mortality rate was 24.6%. Patients who failed NIV were older, and had higher respiratory rate, PaCO 2 , D-dimer levels before NIV and higher minute ventilation and ventilatory ratio on the 1-st day of NIV. No healthcare workers were infected with SARS-CoV-2 during the study period. Conclusions NIV is feasible in patients with COVID-19 and AHRF outside the intensive care unit, and it can be considered as a valuable option for the management of AHRF in these patients.

Outcomes of COVID-19 Patients Intubated After Failure of Non-Invasive Ventilation: A Multicenter Observational Study.

“…Several previous studies described COVID-19 patients who underwent NIV outside ICU, often including patients receiving NIV as "ceiling" treatment (15,16,19,(21)(22)(23)28). Only a minority of these studies, however, reported the incidence of mortality of patients who were intubated after NIV failure.…”

“…While previous investigations were focused on the outcome of NIV delivered out of ICU (15,16,19,(21)(22)(23)28), our study provides detailed information on the outcome of intubation after NIV failure. Worth remarking, our data do not allow drawing any conclusion on the bene ts of the application of NIV outside the ICU, as we do not consider the multitude of patients successfully treated with NIV in settings other than ICU in Veneto region during the study period (12).…”

“…Recent studies showed that a short NIV trial could be bene cial to treat COVID-19 mild-to-moderate hypoxemic ARF (6-14). These investigations, however, were focused on the e cacy, safety and predictors of NIV failure applied outside the ICU (15)(16)(17)(18)(19)(20)(21)(22)(23). Few studies reported the rate of NIV application in ICU, ranging from 11-50%, but the outcomes of critically ill patients, intubated after NIV failure, remain to be explored (6-9).…”

The effect of RAAS inhibitors on acute hypoxemic respiratory failure and in-hospital mortality in the hypertensive Covid-19 patients

“…AHRF was defined as partial oxygen pressure (PaO 2) <60 mmhg or oxygen saturation (SaO 2 ) less than 93% measured by pulse oximeter accompanied with respiratory distress symptoms and need for oxygen greater than 6 L/min. The patients with a partial arterial carbon dioxide (PaCO2) pressure higher than 50 mm Hg were excluded ( 18 , 19 ).…”

Can We Reliably Predict the Failure of Noninvasive Ventilation in COVID-19–associated Acute Hypoxemic Respiratory Failure?

“…However, we believe that PaO 2 /FiO 2 is a rather questionable option for predicting In our recent study, in COVID-19 patients receiving NIV outside the ICU, the baseline PaO 2 /FiO 2 index also did not differ between the success and failure groups, but we found that patients who failed NIV had higher minute ventilation on the first day of NIV (due to slightly higher tidal volume and higher respiratory rate) (6), which, of course, may increase the risk of self-inflicted lung injury (SILI). These findings are in line with Bellani's data, which also showed that the patients failing NIV had lower PaCO2 levels.…”