Noninvasive Ventilation in the Management of Respiratory Failure Due to COVID-19 Infection: Experience From a Resource-Limited Setting

Abstract

Introduction The role of NIV in SARS-CoV2 (COVID-19) related acute respiratory failure (C-ARF) is unclear. Methods C-ARF patients managed on NIV were categorised as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as Odds ratio (OR) with 95% Confidence Interval (CI). Results Between 1 st April 2020 and 15 th September 2020, 286 patients, age (Mean, SD) 53.1±11.6 years and APACHE-II score 11.1±5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe Acute Respiratory Distress Syndrome (ARDS). When compared with NIV success, NIV failure was associated with lower admission PaO 2 /FiO 2 ratio (p<0.001) and higher respiratory rate (p<0.001). On penalized logistic regression analysis, NIV failure was associated with higher APACHE (OR 1.12; 95%CI 1.01-1.24), severe ARDS (OR 3.99; 1.24-12.9), D-dimer ≥1000 ng/ml (OR 2.60; 1.16-5.87), need for inotropes or dialysis (OR 12.7; 4.3-37.7) and nosocomial infections (OR 13.6; 4.06-45.9). Overall mortality was 30.1%. In patients requiring intubation, time to intubation was longer in non-survivors than survivors (Median IQR 5 (3-8) vs. 3 (2-3) days, p<0.001). Conclusions NIV can be used successfully in C-ARF. Illness severity and need for non-respiratory organ support predict NIV failure.

Longitudinal Assessment of ROX and HACOR Scores to Predict Non-Invasive Ventilation Failure in Patients with SARS-CoV-2 Pneumonia

“…An indirect evidence of CVS and renal involvement may be thought off by higher vasopressor use and higher incidence of AKI in failure group. Age has been the significant factor which was associated with NIV failure, this has been demonstrated in study by Chacko et al [18]. Age has been associated with poor outcomes, various reasons could be poor host defense mechanisms, multiple comorbidities and poor cardiovascular response to hypoxemia, increased risk of AKI.…”

“…Age has been associated with poor outcomes, various reasons could be poor host defense mechanisms, multiple comorbidities and poor cardiovascular response to hypoxemia, increased risk of AKI. A summary of the studies predicting NIV failure is illustrated in Table 4 [13][14][15][16][18][19][20][21].…”

Noninvasive Ventilation in Treatment of Respiratory Failure-Related COVID-19 Infection: Review of the Literature

“…Chacko et al reported overall mortality in patients who required NIV was 30.1%. On adjusted analysis, mortality was associated with older age (OR, 1.08; 95% CI, 1.04 to 1.12), severe ARDS (OR, 4.04; 95% CI, 1.08 to 15.1), and higher peak D-dimer level (OR, 2.75; 95% CI, 1.19 to 6.37), requirement for intubation (OR, 9.36; 95% CI, 3.38 to 25.94), and need for inotropes and/or dialysis (OR, 9.19; 95% CI, 2.83 to 29.9) (3.1%) [ 48 ].…”

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

“…Of these patients failing NIPPV, 20 (25.3%) died, while 21 were intubated (26.6%) [ 38 ]. Another study of 286 patients found NIPPV was successfully used without the need for intubation in 63.6% ( n = 182; 118 had moderate to severe ARDS) [ 39 ]. NIPPV failed in 82 patients (28.7%), and for patients in whom NIPPV failed and required mechanical ventilation, mortality was 78%.…”

“…NIPPV failed in 82 patients (28.7%), and for patients in whom NIPPV failed and required mechanical ventilation, mortality was 78%. Failure of NIPPV was more common in those with higher disease severity, lower admission PaO 2 /FiO 2 ratio, higher respiratory rates, and need for organ support [ 39 ].…”